Diseases of women, including their pathology, causation, symptoms, diagnosis and treatment : a manual for students and practitioners / by Arthur W. Edis.

  • Edis, Arthur W. (Arthur Wellesley), 1840-1893.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of women, including their pathology, causation, symptoms, diagnosis and treatment : a manual for students and practitioners / by Arthur W. Edis. Source: Wellcome Collection.

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    2nd. The direction of the uterus.—This is often of great importance, as in the case of flexions, thus enabling us to differentiate them from fibroid outgrowths. In some cases where the uterus is embedded in surrounding deposit, as in hsematocele and pelvic cellulitis, it is essen- tial to determine the exact position of the uterus before resorting to as]Diration or puncture. 3rd. The mohilitij of the litems.—In many cases we can readily ascertain the extent of mobility of the uterus by the conjoined manipulation, but where an ovarian or other tumour is in close ap- position with the uterus, it is very important to determine whether the organ be intimately associated with it oi' independent of it. 4th.' The sensitiveness of the uterus.—If the sound be passed with' care into a healthy uterus, little or no inconvenience is produced, but in case of metritis, pain is complained of the moment the point of the sound touches the fundus. 5th. The presence of any foreign body loitliivi the uterus, such as a retained ovum, polypiis, or fibroid tumour, can often be ascertained by means of the sound. Utero-abdominal Exploration.—The employment of the sound, conjoined with abdominal palpation, is often of great service in deter- mining the du'ection and size of the uterus, where, from the presence of an abdominal tumour, conjoined manipulation fails in detecting the position of the uterus, as also in deciding whether the tumour springs from the uterus, is loosely attached to it, or perfectly independent of it. The patient lying in the left later-al position, the sound being passed in utero, is then held by the left hand, whilst the right hand is employed for external palpation. If the sound be now rotated so as to move the uterus, the external hand will be enabled to detect whether the tumour moves with it, as in the case of a fibro-cystic tumour, or is uninfluenced by the movement, as would probably be the case where an ovai'ian tumour was present. If any difiiculty be experienced in difierentiating a fibroid polypus from an inverted fundus uteri, or even a submucous fibroid from a reti'oflexed fundus, the fact of being able to lift the organ somewhat on the sound so as to feel the fundus distinctly behind the pubes, will clear up any doubt upon the subject. TJtero-rectal Exploration.—This is of service in cases of fibroid or other tumours growing from or connected with the posterior wall of the uterus. The sound being introduced into the uterus, the finger per rectum detects any irregularity of the body or cervix. If a small ovarian tumour be situated in Douglas's pouch, this method is often of great value in determining the exact nature of the growth. Utero-vaginal Exploration.—This is really an extension of the ordinary vaginal touch, the sound prolonging our sense of touch into a cavity into which our fingers are unable to reach. The sound being passed in uterum and the finger per vaginam, any irregularities upon the wall of the uterus, alteiution of direction or flexion of the uterus, can thus be readily detected. Inspection of the Vulval Outlet.—The opportunity should always be taken of examining the external parts visually before introducing