File:Operative gynecology - (1906) (14597055257).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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Text Appearing Before Image:
ical Speculum introduced with thePatient in the Knee-chest Posture. TECHNIQUE OF THE EXAMINATION. 361 The knee-chest position is the one position most satisfactory andapplicable in all cases. The patient kneels with her knees separated 10 or 12inches, close to the end of the table, and, keeping the buttocks as high aspossible, lets the back curve in, and brings the side of the face down on thetable. If she squats a little, drooping the buttocks slightly toward her feet,she will be more conveniently disposed for the examination. Sometimes, toget a good expansion, it is necessary to push the thighs in the opposite direc-tion beyond the vertical. If she is under an anesthetic, the best way to holdher in the knee-chest position is for two assistants to stand, one on each side,close up to the body to prevent it from falling sidewise, each grasping the bodywith one arm thrown over the back, and holding the leg in the crotch of theknee with the other hand to keep it from slipping up or down.
Text Appearing After Image:
Fig. 222.—Patient in a Harness in the Knee-breast Position for Cystoscopic Examination.The squatting attitude is a little too much exaggerated for the average case. An apparatus like that shown in the text (Fig. 222) and devised by Dr.G. B. Miller is useful where assistants are scarce, but the thigh bands must notbe allowed to cut into the femoral fold. Calibrating and Dilating the Urethral Orifice.—Before dilat-ing the urethra and introducing a speculum it is well to calibrate it, that is,to measure its diameter in millimeters as a guide to the amount of dilatationneeded to admit a speculum; for example, if the urethral orifice has a diameter 362 AFFECTIONS OF THE URETHRA AND BLADDER. of 6 or 7 mm. only, it can not be dilated up to 10 or 12 mm. without a slightrupture of its margins; calibration in this case would induce one to use aspeculum a size or two smaller than usual. Again, the calibration often showsthat the orifice is already so large that it needs no preliminary dilata

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