Operative gynecology : . en at the umbilicus. Circumference halfway below the umbilicus. Elevation of highest point of abdominal wall above the plane of the anterior-superior spines. Distance from sternal notch to symphysis pubis. Distance from umbilicus to pubis. Distance from umbilicus to right and left anterior-superior spines respec-tively. By such measurements the degree and form of abdominal enlargements aredetermined, whether more in the lower, or in the upper abdomen, or in oneflank, and whether symmetrical or asymmetrical. Photography is a valuable adjunct to descriptive records; the
Operative gynecology : . en at the umbilicus. Circumference halfway below the umbilicus. Elevation of highest point of abdominal wall above the plane of the anterior-superior spines. Distance from sternal notch to symphysis pubis. Distance from umbilicus to pubis. Distance from umbilicus to right and left anterior-superior spines respec-tively. By such measurements the degree and form of abdominal enlargements aredetermined, whether more in the lower, or in the upper abdomen, or in oneflank, and whether symmetrical or asymmetrical. Photography is a valuable adjunct to descriptive records; the photo-graph gives an instantaneous idea of form, often better than an elaboratedescription. The photograph with the patient lying on the table can be takenwith advantage from three points of view: A profile from the side, showing 86 THE GYNECOLOGICAL EXAMINATION. the general enlargement of the abdomen; a profile from below, showing sym-metry or asymmetry; while a quartering view, halfway between these two posi- ;{, V*^ V. pIG 49.—Sagittal Section through Adult Body, showing the Normal Position and Relations ofthe Uterus, Bladder, Rectum, and Abdominal Walls. The intestines are not shown, and the dotted line represents the outline of the pelvic bones. It is im-portant to note the proximity of the anterior abdominal wall to the sacral promontory. tions and looking rather down on to the abdomen gives a general view of therelations of the parts of the tumor to the abdominal landmarks. When possi-ble, the umbilicus should be included in the picture, as the most important INSPECTION. 87 landmark. A profile view, with the patient erect, shows the anterior displace- ment of a large tumor. Marked departures from the normal may occur within the limits of health,of which the most frequent are distention from tympany or the accu-mulation of fat in the omentum and abdominal walls. Tympany pro-duces a symmetrical form, by the uniform expansion of the intestines in all
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectgynecology, bookyear1
