File:Operative gynecology - (1906) (14783222202).jpg

Identifier: operativegynecol001kell (find matches)
Title: Operative gynecology :
Year: 1906 (1900s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943
Subjects: Gynecology Gynecology Gynecologic Surgical Procedures
Publisher: New York and London : D. Appleton and company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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ion may be made and the speculumintroduced without much discomfort. Posture of the Patient.—Two postures are available, an elevateddorsal and a knee-chest. The dorsal position is the more convenient to useand the least tiring to the patient, but it is only of service in thin patients,and the atmospheric expansion is not so good; the bladder of a fat woman willrarely distend at all in this posture. The head and thorax rest on the table,while the pelvis is raised by putting one or two bran cushions under the but-tocks, so as to elevate them 20 or 30 cm. (8 or 12 inches) or more abovethe table level. This gives a pitch to the pelvic and lower abdominal viscerawhich makes them gravitate toward the diaphragm, and as soon as a speculumis introduced the bladder sucks in air enough to distend it.24 360 AFFECTIONS OF THE URETHRA AND BLADDER. When the bladder does not expand, and yet it is particularly desirable touse the dorsal position on account of the inability of the patient to stand the
Text Appearing After Image:
Fig. 220.—Examination of the Bladder in the Dorsal Position, with Elevated Pelvis. The electric light held close to the symphysis is reflected by the head mirror into the bladder. Theangle of reflection must be as small as possible, so as to avoid constantly displacing the pencil of lightwith slight movements of the head. inconvenience and fatigue ofthe knee-chest position, thebladder may be distended andthe pelvis relieved of the smallintestines by first placing herin the knee-chest position fora minute and letting in airwith a catheter; she is thenturned on her back with hipselevated on the cushions, tak-ing care to keep the pelvis allthe time well above the levelof the abdomen. The specu-lum may now be introducedand a satisfactory examina-tion made. A bladder dis-tended in this way will oftenremain well distended untilthe hips are let down again tothe table level.

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