. The diagnosis of diseases of women . ous of the lesions would have been overlooked. Such experiencesteach us that we are not to be content with the finding of a singlecause for a given symptom, but are to search for all possible causes,inasmuch as two or more morbid conditions may contribute to thesymptom. In making a physical examination care should be taken for fearof injury to the structure examined; and the examiner will always( 56 ) PHYSICAL EXAMINATION 57 endeavor to avoid inflicting pain. The more skilled the examinerthe more careful and gentle he will be. A vaginal examinationmay cau
. The diagnosis of diseases of women . ous of the lesions would have been overlooked. Such experiencesteach us that we are not to be content with the finding of a singlecause for a given symptom, but are to search for all possible causes,inasmuch as two or more morbid conditions may contribute to thesymptom. In making a physical examination care should be taken for fearof injury to the structure examined; and the examiner will always( 56 ) PHYSICAL EXAMINATION 57 endeavor to avoid inflicting pain. The more skilled the examinerthe more careful and gentle he will be. A vaginal examinationmay cause great discomfort, and serious damage may be done toan inflamed mucous membrane and malignant growths. As theresult of a bimanual examination roughly made, not only muchsuffering may be caused, but cysts may be ruptured, abscesses maybreak into the peritoneal cavity, the gestation sac of an ectopicpregnancy may burst, adhesions may be torn, and in the use of thesound, curette, and speculum, serious and even fatal injuries may Fig. 1. Examining table. (Schmidt.) be sustained. While an exact diagnosis is desired in the firstexamination, it is seldom absolutely necessary and is frequentlyimpossible. Certain procedures, such as catheterizing the uterus,must often be postponed for a subsequent examination. It is seldom necessary to make an examination during the men-strual period. It is not only objectionable to the patient, but at thistime the pelvic viscera are congested, and there is an added riskof injury. During the menstrual period the cervix is softened andsomewhat patulous, and for this reason Simpson has advised the 58 GENERAL DIAGNOSIS exploration of the uterine cavity during menstruation for the detec-tion of foreign growths. The added risk of infection and injurywould seem to contraindicate such a practice. We therefore elect the intermenstrual period for local examina-tions and treatments, for the reasons that the conditions then foundare more nearly normal and there
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