Volume 1

System of gynecology / by American authors ; edited by Matthew D. Mann.

Date:
1887-1888
Catalogue details

Licence: Public Domain Mark

Credit: System of gynecology / by American authors ; edited by Matthew D. Mann. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    763/806 (page 753)
    double touch, which is esijecially painful, may be avoided. With the woman upon her left side the left index finger is introduced into the rectum, and the thumb of the same hand into the vagina, or with the woman upon her back tlie right iudex may be used for the rectal explo- ration and the right thumb for the vaginal. In this way the thickness and density of the tumor iu the Douglas space may be clearly made out more readily thau by any other method, as well as its non-connec- tion with the uterine body and cervix. By the vaginal touch we show the marked forward displacement of the uterine body. In the instance of larger pelvic masses the abdomen is enlarged and rounded, and the tumor may be felt approaching the umbilicus and spreading towaixl the ilia. By vaginal exploration we discover a condition closely resembling a retroversion of the gravid uterus at three or four months (Barnes). The finger cannot enter the hollow of the sacrum, because it is occuiDied by the retro-uterine mass. The posterior vaginal wall is displaced for- ward and the direction of the canal altered; following the vagina, the finger passes forward and enters the anterior vaginal fornix, which is diminished to a narrow space behind and above the symphysis pubis, where we find the cervix uteri closely compressed against it, some- times even flattened. With some care the finger can be passed in front of the cervix and somewhat laterally, in which movement of the finger the forward limits of the tumor are detected, blending with the cervical Avail so closely that the margins of the latter are defined with difficulty. W^ith the posterior margins of the cervix the tumor is blended in a peculiarly deceptive way, very much as the posterior cervical wall dis- appears in the uterine body in retroversion of the gravid uterus. At first the mass is soft, with a sense of elastic fluctuation. After two or three days it becomes firmer and more tense, or quite solid, caused by advancing coagulation and inflammation with plastic affusion, Avhich more securely walls in the mass. In these large effusions the uterus can be defined from the mass only by aid of the sound. It is needless to add to the cautious reader that this instrument must be used with the greatest gentleness and care. The way is first cleared by emptying the bladder with the catheter, and the sound guided by the fingers forced forward, and some considerable manipulation may be necessary. The curve enters forward and upward, and the point may be felt through the abdominal wall directly over the sym])hysis. By external manipulation the uterus may be felt ujion the point of the sound, its lateral walls defined, and the tumor moved with- out imparting any motion to the uterus. This shows that the tumor is imconnected with the uterus. Leaving the sound in the uterine cavity, the finger may be introduced into the rectum, Avhere it detects a rounded, more or less yielding tumor, to which no movement can be imparted by manipulating the sound within the uterus. An exam- VOL. I.—iS