File:Gynecological diagnosis (1910) (14777645062).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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rectal touch, the finger of one handbeing in the vagina, and the forefinger of the other hand in therectum. The presence of new growths and strictures in therectum is diagnosed by the rectal touch. Too great care can not be exercised in washing the hands beforechanging from a rectal to a vaginal examination and vice versa,because of the danger of transferring infective matter from one organto the other. In the case of acute infective inflammation of thevulva and vagina, it is wiser not to examine the rectum at all.Often the rectal examination may be deferred as well to a later date. PALPATION 53 By the rectum it is possible to palpate the branches of the sacralplexus of nerves where they course along the sides of the pelvis,and also to palpate a psoas abscess or disease of the sacro-iliacarticulation. (d) The bimanual recto-abdominal touch is the same as thebimanual vagino-abdominal touch as regards the structures whichare reached, except that greater opportunity is generally afforded
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Fig. 11.—The Sims Position. for exploration of the cul-de-sac of Douglas and its contents, thanby the bimanual vagino-abdominal touch. Digital exploration of the bladder is an unjustifiable procedure, asall the information obtained by touch may be gained by a speculumexamination and by vaginal and rectal touch. The danger ofincontinence of urine is too great to justify introducing the fingerthrough the urethra, no matter how small the finger may be. (e) Gynecological Positions other than the Dorsal Position.—Besides the dorsal position which has been described already, thereare several other positions into which the patient is put for pur-poses of examination. 54 PHYSICAL EXAMINATION They are:—the Sims, the knee-chest, the lithotomy, the raisedpelvis, and the standing positions. The Sims position is not so frequently used now as in the yearsfollowing the invention of the Sims speculum. Still, it is of greatservice both for the use of the speculum and other instruments,for practi

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