. The diagnosis and treatment of diseases of women. in the vagina and the fingers over the abdomen and carefully examined by indirecttouch (Figs. 63, 64). Byit, the body of the uterusis located and region to each side ofthe uterus is palpated andalso the space back of theuterus. It is determinedif there is any abnormalmass in the pelvis or ifthere is any area ofmarked tenderness. To the beginner in gy-necological work, this im-portant bimanual exam-ination is often unsatis-factory. He has heard agreat deal about tubaland ovarian disease, andhe expects to feel thetube and ovary at
. The diagnosis and treatment of diseases of women. in the vagina and the fingers over the abdomen and carefully examined by indirecttouch (Figs. 63, 64). Byit, the body of the uterusis located and region to each side ofthe uterus is palpated andalso the space back of theuterus. It is determinedif there is any abnormalmass in the pelvis or ifthere is any area ofmarked tenderness. To the beginner in gy-necological work, this im-portant bimanual exam-ination is often unsatis-factory. He has heard agreat deal about tubaland ovarian disease, andhe expects to feel thetube and ovary at examines a patient, orseveral patients, and can feel neither tube nor ovary, if they are normal. Then heis discouraged, and thinks that he has learned nothing from the examination. Andprobably he has not learned much, for the simple reason that he was feehng forsomething that he could not feel, and did not know the significance of what he didfeel. Close attention to the details of the examination will prevent this unprofit-able Fig. 63. Bimanual Examinatinn, showing also the disposition of outside fii>gers and left thumb. (Kelly— Operative Oynecology.) PALPATION OF THE BODY OF THE UTERUS 53 The information concerning the Bimanual Examination may be divided as fol-lows: Palpation of Uterus—Position, Size, Shape, Consistency. Tendeiness,Mobility, Attachments. Palpation of Tubo-ovarian Region—Tenderness, Mass or Induration. Palpation of other Regions—Tenderness, Mass or Induration. General Observations—Importance of the Educated Touch, Train OneHand, Use Two Fingers, Examine Deeply in Pelvis, May Draw DownUterus, Preferable Position for Examiner, Conditions in DifferentPatients, Get Intestines out of the Way, Diminish Tenderness.
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