A system of gynaecology : with three hundred and ninety-three illustrations ; based upon a translation from the French of Samuel Pozzi / revised by Curtis M. Beebe.
- Beebe, Curtis M.
- Date:
- 1894
Licence: Public Domain Mark
Credit: A system of gynaecology : with three hundred and ninety-three illustrations ; based upon a translation from the French of Samuel Pozzi / revised by Curtis M. Beebe. Source: Wellcome Collection.
Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
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![This greater elevation of the pelvis causes the intestines to fall toward the diaphragm and permits a more easy exploration of the pelvic organs. This position is of great help to the operator by re- lieving pelvic pressure in examinations, especially of small tumors of the uterine appendages. To facilitate exploration and to render the pelvic organs more accessible during an operation it is equally useful to have an assistant lift up the uterus with two fingers in the vagina, or to employ, for the same purpose, an inflated air-pessary. Sims' position.—In gynaecology only the modified lateral or ab- dominal lateral, better known as Sims' position, is in general use. It is adapted for examination with the speculum of the same author. (The weight of the viscera falling forward, the air then easily sepa- rates the vaginal walls.) This position is of great service in various cases. Finally, it caters to the modesty of some women. The woman should lie on the side at the edge of a bed or table, the legs flexed on the thighs at a right angle. The lower limbs are supported by an assistant or by a sidepiece to the table The trunk, in place of resting on the side, undergoes torsion so that the face is turned toward the table; to facilitate this the corresponding arm is dis- engaged from under the trunk and embraces the table. Germ-pectoral ]><>sif't<»t.—Women scarcely ever submit to this position, and it is only exceptionally necessary in cases of displace- ment. By lowering the viscera it lowers the abdominal pressure, allows the uterus to incline forward and balloons the vagina by allowing the air to rush in as soon as the walls are separated. The woman is put on all-fours, on knees and elbows, the nates project- ing a little over the edge of the table. According to the corpulence of the woman she may rest on the elbows or chest. This position i^ cramped and becomes painful if long maintained. Simple abdominal palpation—The patient is placed in the dorsal position, with the knees slightly flexed. She is told to breathe without effort, mouth open, and to relax the muscles. Care is taken to have the bladder and rectum empty. The operator's two hands are simultaneously employed. They must not be cold, for fear of reflex contractions. At first, proceed very gently and then, after having accustomed the abdomen, so to speak, to manipulations, employ more force and sink the fingers into the abdominal walls for a deeper exploration. It has even been claimed that a certain amount of massage disarms the reflexes. Proceed methodically, palpate first the hypogastric region, then the iliac fossa* in such a way as to determine the changes in the volume or situation of the internal genital organs. Finally turn to the flanks, to the epi- gastrium and to the hypochondriac regions. The normal consistence of the abdomen presents variations that it is necessary to take into account. The age of the patient, the absence of anterior fat. multiparity, the thinness or the obesity, the](https://iiif.wellcomecollection.org/image/b2103431x_0059.jp2/full/800%2C/0/default.jpg)
