. The diagnosis and treatment of diseases of women. Patient in Sims postureover the under one. 5. When the vagina is to be packed, either forholding the uterus forward or for hemorrhage. 6. In clearing out the uterus with the curet forincomplete miscarriage. In many such cases wherethe miscarriage has just taken place, if the patientbe placed in the Sims posture and all the manipula-tions made carefully, the uterus may be thoroughlycleared out with but little pain and hence without ananesthetic. Fig. 97. View from above, showingthe arm behind the patient. (Dickin-son— American Text-Book of Obs
. The diagnosis and treatment of diseases of women. Patient in Sims postureover the under one. 5. When the vagina is to be packed, either forholding the uterus forward or for hemorrhage. 6. In clearing out the uterus with the curet forincomplete miscarriage. In many such cases wherethe miscarriage has just taken place, if the patientbe placed in the Sims posture and all the manipula-tions made carefully, the uterus may be thoroughlycleared out with but little pain and hence without ananesthetic. Fig. 97. View from above, showingthe arm behind the patient. (Dickin-son— American Text-Book of Obstet-rics.) 86 THE PHYSICAL EXAMINATION 7. When treating a sinus or abscess opening in the posterior vaginal making the incision bade of the cervix for pelvic abscess, tlie dorsal postureis the better one, as the cervix may be held out of the way by strong traction,but in the after-care of the case, the Sims posture is usually preferable. It causesthe patient less pain and gives much better exposure of the opening back of Fig. 98. Introducing the Sims speculum. Fig. 99. Speculum in place, and showing also themethod of holding the same and of keeping the upperbuttock out of the way. EXCISION OF TISSUE FROM CERVIX FOR MICROSCOPIC EXAMINATION. In many cases the naked-eye examination of the cervix is not sufficient to makea positive diagnosis between malignant disease and certain other affections of thecervix. In a suspicious case, particularly one that resists treatment, a small pieceof the affected area should be excised for microscopic examination. A very con-venient instrument for this purpose is the specimen scissors shown in Fig. this a small piece of the suspicious tissue may be dipt out of the there is much bleeding, a suture may be placed under the bleeding surface andtied. Usually however a styptic application, with a firm vaginal packing, will stopthe bleeding. The specimen excised from the cervix and also all curettingsshould
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