A manual of gynaecological practice : for students and practitioners / by A. Dührssen ; translated and edited from the 6th German ed., by John W. Taylor and Frederick Edge.

  • Dührssen, Jacob Alfred, 1862-1933.
Date:
1900
Catalogue details

Licence: In copyright

Credit: A manual of gynaecological practice : for students and practitioners / by A. Dührssen ; translated and edited from the 6th German ed., by John W. Taylor and Frederick Edge. 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.

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    bined method of examination is earned out unless tbe <lisease is directly visible on the outer genitalia directly the glance is directed to these parts (condylomata, in-' flammation, swelling, prolapse and ruptui'c of perinseum, etc.) The com'bined or bi-manualexamination * con- * [On bi-manual examination :—In following the directions given for the bi-manual and other examinations, it must always be remem- bered that the patient is supposed to be lying in the lithotomy posi- tion at the edge of the table, and the examination is made from the middle line. In England, examination with the patient lying on the left side is almost universal, and the bi-manual can be made in this position almost as well as when the patient is lying on her back. The patient's clothes are thoroughly loosened at the waist so that the surgeon's left hand can be placed directly on her abdomen : the right forefinger is passed into the vagina, and between the right forefinger in the vagina and the left hand on the abdomen, the uterus and its appendages and any tumour that may be present is thoroughly seized and examined exactly as described in the text. In this (lateral) position, however, the uterus and any small movable tumour is apt to fall to the left side (on which the patient is lying), and after the chief features of the case have been made out, it will often be found advisable to turn the patient on her back, retaining the finger of the right hand in the vagina, and with the kuees drawn up (which, together with the abdomen, may be completely covered by a rug) to complete the bi-manual examination in the dorsal posi- tion. This will establish the exact relations of the pelvic organs and any tumour that may be present. Note that this corresponds almost exactly to the method of Thure Brandt described in the text, with the important exception that in the latter method the surgeon stands on the left of the patient, pal- pating the abdomen with his right hand and examining the vagina with his left forefinger. In the English method, the surgeon stands on the patient's right; he palpates the abdomen with his left palm and fingers, and uses his right forefinger for vaginal examination.— J. W. T.]