File:Gynecological diagnosis (1910) (14591338108).jpg

Identifier: gynecologicaldia00burr (find matches)
Title: Gynecological diagnosis
Year: 1910 (1910s)
Authors: Burrage, Walter L. (Walter Lincoln), 1860-1935
Subjects: Women
Publisher: New York, London, D. Appleton and Company
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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in order to get a correct idea as to injuries which maybe present. The vaginal touch informs us as to the contents ofthe rectum, whether empty or containing hard fecal masses, semi-solid feces, or dilated by fluid or gas; also whether or no the blad-der is distended. In order to practice this sort of palpation successfully re-quires a long experience and a thorough familiarity with thenormal conditions, also the variations of the normal in differentindividuals. Abnormalities of the vagina are to be detected by touch; suchare cysts, partial septum, narrowing of the lumen by cicatrice-, 38 PHYSICAL EXAMINATION the sequelae of old inflammatory action, or from congenital defectsof development; also roughness, as in granular vaginitis. On palpating the anterior wall of the vagina the urethra is felt,and thickening or sensitiveness of this structure—evidences ofinflammation—are detected. So also the base of the bladder is tobe touched to determine thickening or points of tenderness, in-
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Fig. 5.—Diagrammatic Drawing, Illustrating the Bimanual Touch. dicating the situation of ulcerated areas in the bladder mucosa.The ureters when thickened are easily palpable running from thebladder base toward the sacro-iliac synchondroses. The uppercourse of the pelvic portion of the ureters can be best detected byrectal examination. (6) The Combined Bimanual Vaginal and Abdominal Touch.—When the tip of the examining finger reaches the posterior PALPATION 39 fornix of the vagina the physicians right hand is laid gentlyon the lower abdomen, palm down with the heel of the handjust above the symphysis pubis. Very gentle and slowly appliedpressure is made with this abdominal hand, all sudden movementbeing avoided as calculated to excite pain and consequentlyresistance of the abdominal muscles. The balls and not the tipsof the fingers are used. The pelvic organs are carried down bythe pressure above until they are within reach of the finger inthe vagina, and conversely they are raised

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