. The diagnosis and treatment of diseases of women. e uterus down no further thanis absolutely necessary to satisfactorilypalpate it. In most of these cases allthat is necessary is a slight downwarddisplacement, that permits the fundusto go somewhat back-ward so that itcan be grasped well between the r-ectalfingers behind and the abdominal fing-ers in front. The extreme cloAvnwarddisplacement of the cervix, to the vag-inal entrance or even outside, is notnecessary nor advisable, except in caseswhere there is already prolapse of theuterus. The occasion for it does ariseif the fingers are carrie
. The diagnosis and treatment of diseases of women. e uterus down no further thanis absolutely necessary to satisfactorilypalpate it. In most of these cases allthat is necessary is a slight downwarddisplacement, that permits the fundusto go somewhat back-ward so that itcan be grasped well between the r-ectalfingers behind and the abdominal fing-ers in front. The extreme cloAvnwarddisplacement of the cervix, to the vag-inal entrance or even outside, is notnecessary nor advisable, except in caseswhere there is already prolapse of theuterus. The occasion for it does ariseif the fingers are carried up the rectumby invagination of the pelvic floor, as above described. (c) The suggestion to use the whole hand in the rectum for exploration in difficultcases, was long ago made and carried out with disastrous results. This methodshould not be used. It has led to rupture of the rectum, with fatal , no need for it is experienced if the palpation with two fingers is carriedout with close attention to the details above Fig. 103. Palpating the pedicle of a tumor,witli tlie tumor pushed up into the abdominalcavity and the uterus caught with a tenaculum-forceps and pulled downward. (Montgomery—Practical Gynecology ) RECTO-VAGINO-ABDOMINAL PALPATION. In some cases, additional information may be obtained by this method. Withthe two fingers in the rectum, the thumb of the same hand is passed into the vaginaand the lower part of the pelvic mass or of the uterus is grasped between the fingersand the thumb, the structures being pressed down within reach by the abdominalhand (Fig. 104). In some cases, this is of decided assistance in outlining a small mass low in the DIAGNOSTIC CURETMENT 95 pelvis and in determining the exact consistency of different parts of it. In certaincases, where there is a wide vaginal opening and relaxed pelvic floor, the examinermay palpate the uterus or other mass low in the pelvis, with almost as much accu-racy as though it were
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