Gynecological diagnosis (1910) (14754993626)

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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incarcerated uterus,or an incarcerated tumor of the pelvis, often necessary to establisha diagnosis, the knee-chest position is invaluable. The lithotomy position is the dorsal position with the thighsflexed on the abdomen. The position is maintained by leg holders,of the Von Ott, Robb, or the Clovers crutch patterns, by differentforms of slings holding the flexed thighs to the shoulders of the 58 PHYSICAL EXAMINATION patient with straps, or by leg holders attached to the operatingtable. The patient is placed in the lithotomy position just asin the dorsal position, with the addition that the thighs are keptflexed by some device. Without any apparatus whatever it ispossible, and often convenient, especially in short operations,such as curetting, for one assistant to hold both legs with onehand and have the other hand free to assist the physician. Todo this, the assistant, generally a nurse, places herself on the leftside of the table (the patients right side), facing the physician, who
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Fig. 15.—The Lithotomy Position. is seated in the chair at the foot of the table. She reaches across thepatients flexed limbs with her left arm, letting the right knee restin her left axilla and grasping the left leg with her left hand. Thusher right hand is free to hold instruments for the doctor. The lithotomy position is used for examinations under ether,for operations, and for investigations where it is necessary toscrub up and asepticize the vulva and surrounding regions. The raised pelvis position, used only in cystoscopic examina-tions, is an exaggerated lithotomy position. It is best obtainedon a table which has a mechanism for the Trendelenburg posture, PALPATION 59 but may be secured by placing a hassock or hard cushions coveredwith towels under the sacrum, so that the pelvis is elevated aboutten inches above the level of the table, the legs being held by aRobb leg holder or by an assistant standing on a stool or box.This position tilts the pelvis backward and removes abdo