Volume 1

Operative gynecology / by Howard A. Kelly ; with ... illustrations for the most part by Max Brödel.

  • Howard Atwood Kelly
Date:
1906
Catalogue details

Licence: Public Domain Mark

Credit: Operative gynecology / by Howard A. Kelly ; with ... illustrations for the most part by Max Brödel. Source: Wellcome Collection.

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    outdoor department simply for the ether examination usually go home late in the afternoon of the same day, but it is better, as a rule, to keep them quietly in bed for a full day afterward. Exposure of any part of the body during the. examination must be guarded against as much as possible, no matter what the patient’s station in hfe may be, partly on the ground of a proper respect for the sex in general, partly because of the sacred obligation to treat the patient in her helpless condition with that deference which is her due in return for her confidence in putting herself in this way into her physician’s hands, and partly because of the inevitable demoraliz- ing effect on nurses, the doctor, and assistants that comes from a careless in- difference to the dictates of a proper modesty. While the patient is being ex- amined no persons not directly interested, professionally or otherwise, should be present. | Classes of students must be admitted to the examining room in limited numbers only; in no case should more than three or four students examine the same patient, and the physician who is responsible for her must exercise a eonstant watchful care to keep any student from examining too long and from using: unnecessary force. The hands must be specially prepared for the examination by a thorough serubbing with soap and warm water, and by cutting the nails short, so that they will not. bruise the skin in making the bimanual examination. After each ex- amination the hands must be washed afresh to prevent carrying contamination from one case to another. An examination should never be made with a sore hand. Vaseline is a good lubricant for the vaginal and rectal fingers. When the hymen is intact, the examination should be made, as stated in the rules, under an anesthetic; in this condition it is sometimes possible to introduce a small finger into the vagina without making any rupture, but it is better to omit the digital examination by the vagina entirely, and to conduct it wholly through the rectum and abdominal walls. If it is necessary to catch the cervix and draw the uterus down to get at the tubes and ovaries, this may be done by ‘introducing into the vagina the bullet forceps closed, and then, guided by the rectal finger, which feels the cervix distinctly, to open the forceps and grasp the cervix. A perfectly satisfactory inspection of the vagina, without injury to the hymen, may be made by using a small eyindaica] i eicamai with the patient in the knee-chest position. The Examination—The various methods of handling the normal pelvic organs and the different avenues of access to them are also used in investigating © the diseases of these organs; and the knowledge acquired in gaining a thorough familiarity with the condition and relations of the healthy organs is indis- pensable in estimating the presence and extent of disease, for the normal con- dition is the only standard of comparison. Owing to a want of familiarity with the normal structures, operators have frequently made the frightful mis- take of removing sound organs.