Clinical lectures on the diseases of women and children / by Gunning S. Bedford.

  • Bedford Gunning S., 1806-1870.
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lectures on the diseases of women and children / by Gunning S. Bedford. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    149/696 page 127
    volume. In this latter case, ho'wever, the valved instrument ■will be preferable, for the reason that there will be less probability of inflicting injury upon the diseased surfiice. Also, in cases in which it becomes necessary to make application to the walls of the vagina, as, for example, in granular vaginilis, etc., the latter form of speculum is to be employed. On account of the cheapness, the cylindrical glass instrument answers very well, but an objection to it is its fragility, and the occasional injury inflicted on the patient by its breaking in the vagina, owing to clumsiness in its use. Here I show you an ivory instrument, which I am in the habit of using; for ordinary purposes, it is, on many accounts, the best you can employ. The object of the speculum is, I repeat, to afford the prac- titioner an opportunity of seeing the part affected, and of accurately applying to it whatever remedy his judgment may suggest. I have often remarked to you that, comparatively speaking, I rarely have re- course to the speculum as a means of diagnosis; I much prefer the sense of touch. This I have sedulously cultivated, and find no difficulty, under ordinary circumstances, in arriving at a correct data with it alone. I advise you, gentlemen, to cultivate this sense of touch—it will spare many a pang to your suffering patient, and produce very satisfactory results. On more than one occasion I have found it necessary to protest against the use of the speculum, for the double reason that it was un- necessary, and added a keen edge to the already melancholy anguish of the invalid. For example, in the ulcerated stage of carcinoma, what will justify the introduction of the speculum as a means of diagnosis ? The physician who should require this instrument under such circumstances, would be just as much in the dark after its employment as he was be- fore ! Carcinoma, especially in its ulcerated form, speaks a very intel- ligible language—the simple touch of the educated practitioner will cause a complete and prompt recognition of this fearful malady. I remember on one occasion witnessing very serious consequences from the inoppor- tune use of the speculum. It was a case of cauliflower excrescence of the cervix uteri. The instrument was thoughtlessly thrust against the dis- eased mass—the delicate pelicle covering the granules, which consist of a congeries of vessels, was thus ruptured, and profuse hemorrhage followed. In introducing the speculum, the patient should be placed on her back, the hips brought to the edge of the bed, each foot resting on a chair. The room should be darkened, and when the instrument is. properly introduced, a light should be applied, which will enable the practitioner to make the necessary application to the diseased surface. You should be careful not to expose your patient; and, as you perceive in the case before you, exposure is not necessary to the successful em- ployment of the speculum. [Here the Professor introduced the instru- ment.] The speculum being well covered with oil, you separate, with the index and middle fingers of the left hand, the labia majora—the in- strument is then introduced, not violently, but gently and cautiously
    digitised image 1
    digitised image 2
    digitised image 3