Lessons in gynecology / by William Goodell.

  • William Goodell
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Lessons in gynecology / by William Goodell. Source: Wellcome Collection.

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    case. Simon claimed that by it lie could reach as far up as the lower end of the kidneys, and could feel and map out all intervening organs. I have not yet met with a case in which I felt warranted in resorting to this mode of investigation; but, as it is plainly of value, I shall describe the manner of performing it: After being profoundly anaesthetized, the woman is placed on a table in an exaggerated lithotomy position. The sphincter ani is next well stretched open, and its hind portion deeply nicked. The closed and well-greased hand is then slowly coaxed into the rectum. The fingers can now readily explore the pelvic cavity as far up as the promontory of the sacrum. Should a higher reach be needed, two or three fingers are gently insinuated into the sigmoid flexure, which, being very movable, can be pushed up as far as the navel. In the examination of virgins, in order to save the hymen, and to give as little pain as possible, it is my habit to get all the information possible through the rectum. The finger in the rectum can very readily map out the post-cervical regions, and, by pressure on the cervix, can push up the womb to the fight hand, which is engaged in abdominal palpation. It is indeed surprising how much knowledge can be gained through this channel. EXAMINATION BY THE BLADDER. Sometimes when the diagnosis of a pelvic disorder is ob- scured, additional information will come from an exploration of the bladder through the urethra, either with the sound or with the finger. For instance, a congenital absence of the womb or its inversion can be learned by making the tip of a uterine sound, passed into the bladder, approach the index finger in the rectum. Or, small tumors of the womb, ab- scesses of the broad ligament, or congested ovaries, can be made out by means of the finger introduced into the bladder itself. The method by which this is accomplished, I shall describe in a lesson upon diseases of the bladder, under the heading of dilatation of the urethra.