File:Gynecological diagnosis (1910) (14797918973).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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lthough it does those1 of the ampulla. The mucous membrane of the rectum is studded by branchingvessels and the openings of little glands may be seen. Inflamma-tion is marked by a diffuse velvety injected appearance of the 126 THE INVESTIGATION OF THE RECTUM mucosa, together with the disappearance of the normal branchingvessels; ulcerations are easily distinguished, polypi may be seenhanging from the rectal wall, or the bleeding surface of a carcinomamay obstruct the lumen of the proctoscope. If there is strictureof the bowel because of syphilis, or cancer, a smaller proctoscopeshould be used. A large-sized Kelly cystoscope will often serveinstead of a proctoscope in such cases, also in the examination ofthe rectum in children. Stretching the Sphincter and Speculum Examination of the Rectum.In exceptional cases it is necessary to give an anesthetic in orderto make a complete diagnosis of rectal disease. In such an event,after the patient is thoroughly anesthetized she is placed in the
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Fig. 63.—Sims Rectal Speculum. Sims position; the operator anoints both thumbs and inserts themthrough the anus. By means of the fingers grasping both buttocksgentle but firm traction is made on the sphincter ani. A good dealof time should be devoted to the stretching of the sphincter, somefifteen minutes. Rapid and forcible stretching is very apt toresult in rupture of the muscle followed by partial or completepermanent incontinence of feces or in fissure of the mucousmembrane. Thorough stretching of the sphincter is an essentialfor any instrumentation of the rectum except proctoscopy. Afterthe preliminary stretching the sphincter muscle is fixed between thethumb and forefinger of the left hand and successive portions ofits periphery are stretched by the thumb and forefinger of the righthand. The Sims rectal speculum is passed and light is reflectedinto the rectum by the head mirror, the alligator forceps and pled-gets of cotton being used to wipe away discharges and feces. CHAPTER

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