Medical gynecology / by Howard A. Kelly ; with one hundred and sixty-five illustrations, for the most part by Max Broedel and A. Horn.

  • Howard Atwood Kelly
Date:
1912
Catalogue details

Licence: Public Domain Mark

Credit: Medical gynecology / by Howard A. Kelly ; with one hundred and sixty-five illustrations, for the most part by Max Broedel and A. Horn. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    displacement of the uterus; a cancer of the rectum, high up, has been repeatedly mistaken for a pelvic tumor of some other kind; and most im])ortant of all, a proctitis, with its j^elvic distress and vague pains is commonly overlooked or mistaken for chronic disease of the ovaries and tubes. I recall also in this conection the cases so much talked about a generation ago, where a fissure of the rectum, causing pains reflected to other parts of the pelvis, was often mistaken for uterine or ovarian disease. It is manifestly important for all these reasons that the gynecologist should include the rectum and its diseases within the scope of his inquiry in almost every case, and further that he should, if necessary, be ready to apply the appropriate treatment. I would lay great stress then upon the rou- tine examination of the rectum. I have no doubt at all that in every hundred cases examined in this way by one who has newly taken up the sub- ject, a number of surprising discoveries will be made. The reason for the neglect of this field in the past has lain in the difficult and unsatisfactory character of the examinations, which elicited no positive information. Even recently, the method in vogue has been to investigate the diseases of the rectum situated above the anal margin with the index finger, which at best cannot do more than reveal a few of the gross changes. A dis- tinguished proctologist and author of a large work on rectal diseases once declared at a large society meeting at St. Louis, that he had no interest in diseases of the rectum that did not manifest themselves to his educated touch! Concurrently with the finger examinations, various thin-bladed bivalve and trivalve specula were used, in the vain hope of seeing as well as feeling some- thing; but these little instruments were in reality almost wholly useless, for they did little more than expose the sphincter area, and as much of the bowel above as might prolapse between the narrow blades of the speculum. It was with rectar diseases as with eye diseases a few decades ago, when the patient had either amblyopia or amaurosis; in amblyopia the patient saw nothing, but the physician saw something, while in amaurosis neither patient nor physician saw anything. Several men, such as Sims and J. G. Carpenter, had looked into the rectum, using a Sims' speculum in a Sims' or an elevated posture, but the action was incidental, and they never appreciated the value of the method enough to advertise it or insist upon its universal acceptance as the one method of the highest importance, and so fundamental and absolutely necessary in all satisfactory examinations and treatments of the rectum above the sphincters. ISTo other person took particular note of their use of the Sims' speculum in this way and nothing was accomplished. One insuperable added difficulty was the want of a proper instrument to make a thorough investiga- tion of the bowel, for the Sims' speculum is but a make-shift. I took up this subject in the eighties, while yet in Philadelphia, and in April, 1895, I pub- lished an article in the Annals of Surgery (vol. 21, p. 468), in which I insisted upon the importance as well as the entire feasibility of always exam- ining the rectum in an elevated posture under air distention, using a long