. The diagnosis, pathology and treatment of diseases of women including the diagnosis of pregnancy. e habit of using, is a little firmer and stronger, 16 242 DIAGNOSIS. and more bent back. It will be found that in drawing down theuterus it is necessary simultaneously to draw the speculum a littlein the same direction. The view thus afforded of the os and the cervix uteri is exceed-ingly^ good. Manipulations on the parts in question are effectedwith extreme facility. The use of the hook is not attended withany bad result, but when the patient is straining, as not unfre-quently happens during th
. The diagnosis, pathology and treatment of diseases of women including the diagnosis of pregnancy. e habit of using, is a little firmer and stronger, 16 242 DIAGNOSIS. and more bent back. It will be found that in drawing down theuterus it is necessary simultaneously to draw the speculum a littlein the same direction. The view thus afforded of the os and the cervix uteri is exceed-ingly^ good. Manipulations on the parts in question are effectedwith extreme facility. The use of the hook is not attended withany bad result, but when the patient is straining, as not unfre-quently happens during the exhibition of chloroform, care is re-quired so as not to lacerate the parts. Fig. 26 represents the large blade in situ, as when first intro-duced. The hook having been inserted is drawn down about aninch in the direction of the vulvar aperture bringing the os uteriwith it. In some cases the bivalve instrument is better than the uni-valve ; but where assistance is easily procurable the latter will begenerally preferred. The new bivalve instrument (Fig. 27) is so superior to the older Fig. instruments, that I do not describe them. The tubular glassspeculum—known as Fergussons speculum—is also very inferiorto it. In a few instances, as when the speculum is used to explore thecondition of the vesico-vaginal septum in cases of fistulge, it is ad-visable to place the patient on her hands and knees, so as to givethe observer a good view of the roof of the vagina. The univalvespeculum is the best to use in this class of cases. The bivalve speculum may be used with the patient in the lith-otomy position, but the other plan is far preferable. It is gener-ally necessary, by means of a dossil of lint held at the extremityof a pair of long dressing forceps, to remove the secretions with EXAMINATION BY THE SPECULUM. 243 which the surface of the exposed part is covered, in order that themucous membrane itself may be inspected. APPEARANCES OF THE OS UTERI, AS REVEALED BY THE SPECUL
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