Operative gynecology - (1906) (14596866650)

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

Text Appearing Before Image:

Fig. 223.—Holding the Vesical Speculum ready forIntroduction; the Thumb presses the Obturatorfirmly IN. TECHNIQUE OF THE EXAMINATION. 363 obturator is kept from slipping back into the cylinder by a decided pressurewith the thumb, continued until the end has entered into the bladder. Theurethra, wiped clean with a boric acid solution, is exposed by an assistantholding the buttocks and the labia well apart, while the point of the speculum,coated with the boroglycerid solution, is applied to the urethral orifice, andpushed through the urethra into the bladder with a gentle sweep around thepubic arch. The handle of the speculum is now firmly grasped, while theobturator is withdrawn with a slight rotary motion. If the internal urethralorifice is drawn well into the pelvis by the posture, the urethra is so muchcurved that there is danger of injuring it by pushing the speculum hardagainst its posterior wall; this must be avoided by introducing the speculum

Text Appearing After Image:

Fig. 224.—Examination of the Bladder with the Patient in the Knee-chest Position. in a decided curve. The moment the obturator is taken out the air rushes inand the bladder is dilated and ready for the inspection. If the bladder does not expand in this way the examiner will usually findthat the patient has assumed a faulty position, and as soon as this is correctedthe expansion occurs. Viewing the Bladder.—It takes far less time to view the whole in-terior of the bladder than it does to describe the method of inspection (Fig.224) ; indeed, after practice, a few seconds will be sufficient to determine byactual sight whether any portion of the interior is sound or diseased. If the patient is in the knee-chest position the examiner sits on a stoolwith his eyes a little below the level of the urethra, grasping the handle of 364 AFFECTIONS OF THE URETHRA AND BLADDER. the speculum, which is turned upward, and-he should wear the head mirrorover the eve which he is accustomed to use at th

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1906

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