File:Operative gynecology - (1906) (14760485696).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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oubt. They occupy peculiar positions in the upper pelvis,are elongate, and markedly movable on account of a long meso-sigmoid; theyare often made up of a number of scybalous nodules. The customary sensi-tiveness must not mislead. Any doubt remaining after such an examina-tion can be cleared up by a purgative or enema, and by an inspection with asigmoidoscope. A digital examination of the anus shows the existence of abnormalities, and EXAMINATION OF THE BECTUM BY PALPATION. 123 when the finger is carried up into the ampulla and the rectum immediatelyabove, it demonstrates the presence of any marked changes, more especially con-striction by inflammatory masses; when the finger passes between the utero-sacral ligaments it seems to be entering a long, rigid tube with smooth walls.Amid the redundant folds of the ampulla it is sometimes hard to find the en-trance into the bowel above. The proper point is best located by taking thecervix as a guide and seeking the opening directly behind it.
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Fig. 72.—Patient Supported by Uprights and Straps in Position for a Rectal Examination. The instruments—conical sphincter dilator, proctoscope, sigmoidoscope, applicator with cottonpledget—are reduced in proportion to the size of the patient. (See p. 121.) Inspection.—Under inspection the whole mucous surface of the lower bowelis exposed to view, from its external orifice up to the sigmoid flexure and colon,and any alterations in color, or unevenness of surface and deposits, together with 124 THE GYNECOLOGICAL EXAMINATION. changes in caliber and points of fixation, are at once evident. To make thebest possible examination in this way, the bowel must be emptied of feces andthe patient placed in the knee-chest posture; the thighs should be vertical, theback well curved in, and the chest as close as possible to the table; the patientshould wear no corsets or any constricting garments on the upper abdomen(Fig. 72). A cylindrical speculum of suitable length and caliber is now intro

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