Licence: In copyright
Credit: Medical gynecology / by Howard A. Kelly. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
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![tlicsia, be drawn well clown to the vulva and so made much more accessible to touch. Bcfoiv making- an examination under anesthesia, the bowels should he well opened, and tlio stomach empty. It is a good rule to liave the patient rest a day or two afterwards. The best anesthetic for such a pur- pose is nitrous oxide gas. The gas can be given and the examina- tion made within three to five minutes; consciousness follows at once, and there is no distressing nausea or depression afterwards. Sometimes after starting the gas, the patient is stertorous and does not relax; a few whiffs of ether combined with the gas then serve to produce entire relaxation, after which the gas alone is continued. It is possible, if it is necessary, for a patient to get up within a few minutes after such an examination and go home. Examination of Virgins.—Young unmarried women ought, for decency's sake, always to be examined for the first time under an anesthetic; in this way their feelings are spared the shock and the distressing ordeal, and the examination made is complete and satisfactory, an exception under such cir- ' cumstances without an anesthetic. It is always well to secure permission at the same time, if only a slight operation is required, siTch as a dilatation for dysmenorrhea, to proceed with it at once, to avoid giving an anesthetic again. The empty rectum is the one important avenue of approach in making a deep investigation imder an anesthetic. The finger should be carried well above the cervix uteri, through the valves, until the posterior surface of the ■ uterus and of the left broad ligament are plainly felt. Too much force must ' not be used in palpating; I have known several instances in Avhich the rectal wall has been perforated by an examining finger, compelling the examiner to suddenly and unwillingly turn surgeon, open the abdomen, and sew up tlie rent. Pain.—When a patient comes with a complaint of a definitely located pain it is most important for the physician, in the course of his examination, to discover which organ is causing the suffering and then, by gentle pressure or manipulations, to try to reproduce the pain so that the patient may feel con- vinced that the source of her discomfort has been located, for if she can declare with conviction that the pain aroused is exactly the same pain, felt in the same spot, he will secure her hearty cooperation in following any rational plan for her relief. Patients sometimes complain of pain in the pelvis, when a careful examination shows that no abnormality can be detected in any organ. Here, as a rule, the pain is complained of whenever any part of the pelvic peritoneum or any pelvic organ is squeezed slightly between the fingers of the two hands. If this fact is carefully noted and remembered, many unneces- sary, often mutilating operations will be avoided. When intermittent attacks of pain are cojuplained of, unless the examiner can dis- tinctly reproduce tlie ])ain or touch the very spot, the patient ouglit to be kept imder observation until a typical attack comes](https://iiif.wellcomecollection.org/image/b21511512_0037.jp2/full/800%2C/0/default.jpg)
