Minor surgical gynecology : a manual of uterine diagnosis and the lesser technicalities of gynecological practice : for the use of the advanced student and general practitioner . -Rutenbergs endo- GYNECOLOGICAL EXAMINATION. 61 urethra and bladder naturally is but a small one, corresponding with thelimited dilatability of the urethral canal, and their practical utility there-fore in no way equals that of specula for other passages. Still, withoutthem the diagnosis of urethral and vesical disease may often be entirelyimpossible. The late Prof. Simon of Heidelberg practised and taught the introdu
Minor surgical gynecology : a manual of uterine diagnosis and the lesser technicalities of gynecological practice : for the use of the advanced student and general practitioner . -Rutenbergs endo- GYNECOLOGICAL EXAMINATION. 61 urethra and bladder naturally is but a small one, corresponding with thelimited dilatability of the urethral canal, and their practical utility there-fore in no way equals that of specula for other passages. Still, withoutthem the diagnosis of urethral and vesical disease may often be entirelyimpossible. The late Prof. Simon of Heidelberg practised and taught the introduc-tion of sounds through the dilated urethra into the mouths of the ureters,for the purpose of detecting abnormal conditions of these ducts. Whatwas undoubtedly possible to his acute touch, will scarcely be feasible forus without an amount of practice entirely out of proportion to the benefitto be derived from the operation. A practitioner so well versed in vesicaldisorders as Winckel, says that notwithstanding great perseverance henever was so fortunate as to find the canal (of the ureter) with the sound. hBW. TrL Fig. 32.—The finger in the bladder touching the mouths of the ureters. (Winckel.) For completeness sake I will merely say that the finger passed throughthe dilated urethra detects the nodule marking each ureteral mouth aboutone inch from the sharp vesical neck on the so-called inter-ureteric liga-ment about to ctm., each side of the median line. If the nodule isdistinctly felt, Simon claims that a sound or catheter (long, blunt-pointed)can be passed along the finger into the slit, and by pressing the handleof the sound toward the opposite ramus of the pubic arch into the ureter,even up to the renal pelvis. Simon succeeded seventeen times in elevenwomen in this maneuvre, without injury to the patient. He advocatedit for the diagnosis of ureteral and renal calculi, ureteral stricture, andthe cure of hydronephrosis. The cases in which it will be indicated ar
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