Gynecological diagnosis . e sphincter is relaxed and theanal canal is straightened. Thus the discomfort is lessened whilethe finger is introduced gradually with a boring motion. The an- 124 THE INVESTIGATION OF THE RECTUM terior and side-walls of the ampulla are palpated. A lesion on theanterior wall is felt between the left forefinger in the rectum andthe right forefinger in the vagina. The strength of the sphincterani is estimated, spasm, due to long-continued irritation, areas ofinduration, ulceration, or narrowing of the caliber of the gut, andthe presence of tumors are determined. A gener
Gynecological diagnosis . e sphincter is relaxed and theanal canal is straightened. Thus the discomfort is lessened whilethe finger is introduced gradually with a boring motion. The an- 124 THE INVESTIGATION OF THE RECTUM terior and side-walls of the ampulla are palpated. A lesion on theanterior wall is felt between the left forefinger in the rectum andthe right forefinger in the vagina. The strength of the sphincterani is estimated, spasm, due to long-continued irritation, areas ofinduration, ulceration, or narrowing of the caliber of the gut, andthe presence of tumors are determined. A general smoothness andabsence of folds indicates atony. The right forefinger, in like manner, is used to palpate theposterior wall of the ampulla. The presence of internal piles isvery hard to diagnosticate by touch. The proctoscope must beused for these. In making the digital examination it is well topass the unused fingers of the examining hand between the nates,or over the vulva and the thumb beside the vulva or between the. Fig. 61.—Long Proctoscope. nates, for in this way a greater distance can be reached in therectum than by shutting the unused fingers on the palm of thehand. If, after the digital examination, the diagnosis is still indoubt, the Kelly proctoscope should be used. Proctoscopy.—A good light, preferably an electric light anda head mirror, are necessary, just as in cystoscopy. The patient isput in the knee-chest position. Something as to the condition ofthe anal canal may be learned by the use of the smallest-size Simsvaginal speculum in the anus and some physicians report goodresults with it. Personally, I have not found it valuable as ameans of diagnosis unless the sphincter has been first Sims rectal speculum is adapted only for use with the patientanesthetized. Two proctoscopes are sufficient for diagnostic purposes. Theshorter one, three inches ( centimeters) long by seven-eighths PROCTOSCOPY 125 inch ( centimeters) in diameter, is pass
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectwomen, bookyear1910
