File:Treatise on gynæcology - medical and surgical (1891) (14774822161).jpg

Identifier: treatiseongync00pozz (find matches)
Title: Treatise on gynæcology : medical and surgical
Year: 1891 (1890s)
Authors: Pozzi, S. (Samuel Jean), 1846-1918 Wells, Brooks H. (Brooks Hughes), b. 1859
Subjects: Gynecology Genital Diseases, Female
Publisher: New York : W. Wood
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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tum and abdomen(Hoist); it is particularly advisable in disease of the adnexa. By the combined method one can palpate the ovaries, with specialfacility if the patient is anaesthetized, but even without such aid.It is well, as Hegar advises, to have the uterus gently pulled downby an assistant, the cervix being fixed with a (tenaculum) forceps 100 CLINICAL AXD OPERATIVE GYNAECOLOGY. while the surgeon palpates the abdomen and passes the index of theother hand by turns into vagina or rectum; the ovary is felt to glidebetween the fingers like a small testicle. The left ovary is more easilyreached than the right, which Olshausen attributes to its position infront of the rectum. With obese patients this method of examina-tion has many difficulties. Instead of adopting Noeggeraths vesico-rectal method, I think it better to have recourse to the plan advisedby Ulmann19 (a pupil of Albert, Vienna) in difficult cases where ovarianpalpation seems indispensable; the bladder being emptied, there is
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Fig. 71.—Bimanual Exploration in Retroversion CDavenport). passed into the rectum a balloon filled with 200-250 gm. of water.Now bimanual palpation reveals the uterus and its appendagesstrongly elevated and held in that position upon a resistant body,which makes them very accessible. Examination by Speculum.—After Recamier had reinvented thespeculum, this valuable instrument led to the neglect of all other ex-ploring methods; from this point of view, one may assert that thegreat service it has rendered to gynaecology has been equalled bythe temporary evil it has caused. The form of the instrument has undergone endless changes; but ofthese, however ingenious, only a small number are absolutely neces-sary. METHODS OF GYNECOLOGICAL EXAMINATION. 101 There are three chief types, the cylindrical, the bivalve or the tri-valve, and the univalve. The Cylindrical Speculum.—This form is particularly suited totopical applications; made of wood or ivory it protects the vaginalwalls from heat

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