Manual of gynecology . and shoulders shouldbe supported and the knees drawn up. Arrangement of Examiners Hands.—The internal hand (the right) isplaced as follows : two fingers (index and middle) are in the vagina, thethumb rests in the fold between a labium majus and the thigh, and theother fingers lie in the cleft of the nates, Fig. 71. The whole hand is 102 MANUAL OF GYNECOLOGY. then rotated backwards so as to bring its long axis as nearly as possibleinto the axis of the brim, and is then pushed up towards the brim of thepelvis. Thus the pubic segment, uterus with annexa, and posterior vagi-
Manual of gynecology . and shoulders shouldbe supported and the knees drawn up. Arrangement of Examiners Hands.—The internal hand (the right) isplaced as follows : two fingers (index and middle) are in the vagina, thethumb rests in the fold between a labium majus and the thigh, and theother fingers lie in the cleft of the nates, Fig. 71. The whole hand is 102 MANUAL OF GYNECOLOGY. then rotated backwards so as to bring its long axis as nearly as possibleinto the axis of the brim, and is then pushed up towards the brim of thepelvis. Thus the pubic segment, uterus with annexa, and posterior vagi-nal wall are lifted up towards the brim. The middle finger is placedover the os and the index one in the anterior fornix, so that the uterusas it is pushed up becomes more anteverted. The right hand while ex-amining, therefore, has the appearance at Fig. 71. The little and ringfingers may be doubled up as in Fig. 72. The external hand (the left) isplaced on the abdominal wall just above the pubis, with its long axis. Fig. examination. The upper hand is not shown (Hart). running obliquely between the iliac crests, its ulnar edge near the pro-montory and much deeper than the radial one. It is now steadily de-pressed until the abdominal wall below it is markedly cupped (Figs. 72and 73) and moulded over the uterus, ovaries, etc., which have beenelevated by the inner hand. In this way the two hands estimate the sizeand relations of the pelvic contents, just as one would estimate the sizeof a watch covered with a cloth. The student should note specialty thatthe upper hand should be steadily and not spasmodically depressed; thathe should always keep the ulnar edge of this hand deeper, that is, nearerthe sacrum, so that he may not retrovert the uterus ; and that he shouldpalpate all the abdominal arete along the pelvic brim so as not to miss EXAMINATION OF THE FEMALE PELVIC ORGANS. 103 anything. His first object in the bimanual examination is to determinewhere the uterus
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Keywords: ., bookcentury1800, bookdecade1, booksubjectgynecology, bookyear1883
