. Clinical gyncology, medical and surgical. s an entering wedge for the speculum. The beak of the bladeof the speculum should then be carried in on the finger, gentle pressurebeing made on the heel of the blade by the thumb. (Fig. 17.) Slighttraction is to be made backward, so as to depress the perineum, it beingremembered that only in this way can room be gained. The speculum 52 METHODS OF GYNAECOLOGICAL EXAMINATION. should hug the posterior vaginal wall, and it should be borne in mind thatthe direction of the vagina at first is backward towards the promontory, oreven the hollow, of the sacru
. Clinical gyncology, medical and surgical. s an entering wedge for the speculum. The beak of the bladeof the speculum should then be carried in on the finger, gentle pressurebeing made on the heel of the blade by the thumb. (Fig. 17.) Slighttraction is to be made backward, so as to depress the perineum, it beingremembered that only in this way can room be gained. The speculum 52 METHODS OF GYNAECOLOGICAL EXAMINATION. should hug the posterior vaginal wall, and it should be borne in mind thatthe direction of the vagina at first is backward towards the promontory, oreven the hollow, of the sacrum. If the speculum is merely pushed in in thesupposed direction of the uterus, it will impinge on the anterior wall andwill be arrested by its folds. It is carried well up into the posterior cul-de-sac, gentle traction on theperineum being made all the time, and is then given to the nurse to hold,who should grasp it by the shank, the back of the blade resting in thehollow between the thumb and the hand. (Fig. 18.) This is the most Fig. Method of holding speculum. convenient way to hold the speculum, as the physician can easily graspthe free blade and change the position if necessary, while it is much lesstiring to the nurse. If the cervix does not easily come into view, the difficulty is usuallybecause the anterior wall obscures it. This must be depressed, for whichpurpose a so-called depressor is used (Fig. 19), or, what is quite as con-venient and serves the additional purpose of cleansing the vagina, a cotton-stick armed with a wad of cotton. (Fig. 20.) METHODS OF GYNECOLOGICAL EXAMINATION. 53 If the anterior wall is pushed forward in the direction of the bladder,and the beak of the speculum is tilted somewhat forward as well, the cervixis usually well exposed. Its peculiarities may then be noted and con-clusions drawn as to the existence of disease. First as to its shape. It is normally conical in shape, the os beinga small oval opening at its end. There are variations
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