. The diagnosis of diseases of women . ble toinsert the finger through the urethra into the bladder for the pur-pose of detecting irregularities and foreign growths. (6) The bladder when empty is seldom recognized in a bimanualexamination. In cystitis tenderness and pain are proportionate tothe intensity and extent of the lesion. In chronic cystitis, and par-ticularly in tuberculous cystitis, the thickened bladder wall may bedistinctly palpated through the vagina. Stone may sometimes bepalpated and outlined in an abdominovaginal examination. Kelly recommends placing the patient in the knee-che
. The diagnosis of diseases of women . ble toinsert the finger through the urethra into the bladder for the pur-pose of detecting irregularities and foreign growths. (6) The bladder when empty is seldom recognized in a bimanualexamination. In cystitis tenderness and pain are proportionate tothe intensity and extent of the lesion. In chronic cystitis, and par-ticularly in tuberculous cystitis, the thickened bladder wall may bedistinctly palpated through the vagina. Stone may sometimes bepalpated and outlined in an abdominovaginal examination. Kelly recommends placing the patient in the knee-chest positionand letting the air distend the vagina, when the fingers of both DIAGNOSIS OF DISEASES OF UBETHBA AND BLADDER 493 hands can be brought close together and the entire bladder bedistinctly outlined. While possible to palpate a portion of the interior of the bladderthrough the dilated urethra, such a procedure is no longer to berecommended in view of the more efficient and less objectionablemethod of direct inspection. Fig. 195. The thickened bladder is engaged between the index and middle finger of the left handin the vagina, and the fingers of the right hand over the abdomen. 3. By Catheter and Sound. By the use of the catheter theurine is evacuated from the bladder and can be examined free ofcontamination with products of the urethra and vagina. By thecatheter foreign bodies, stricture, and fistulse are sometimes detectedin the urethra and bladder. The sound is a more efficient instru-ment for the detection of such conditions. 4. Inspection. Inspection of the urethra and bladder has beenmade possible by the contributions of Nitze, Casper, Pawlik, Skene,Simon, Kelly, and others. In almost all diseases of the urethraand bladder it is desirable to make an exact diagnosis by directinspection, 494 DIAGNOSIS OF DISEASES OF THE URINARY SYSTEM The lesions involving the urethral orifice can be recognized bydirect ocular inspection. Pus seen to ooze from the urethra is,with few
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