Gynaecology for students and practitioners . some instancesmay leave many points undetermined. For a successful bimanual examination it is essential that thebladder should not be full nor the rectum loaded ; whenever possiblea mild aperient should be administered in preparation for the exami-nation, as a second visit to the doctor is thereby often avoided. The only position in which the bimanual examination can bemade is with the patient lying on her back, and the knees bent to anacute angle. When a special gynaecological couch, or operating table,is used the examiner stands between the patien
Gynaecology for students and practitioners . some instancesmay leave many points undetermined. For a successful bimanual examination it is essential that thebladder should not be full nor the rectum loaded ; whenever possiblea mild aperient should be administered in preparation for the exami-nation, as a second visit to the doctor is thereby often avoided. The only position in which the bimanual examination can bemade is with the patient lying on her back, and the knees bent to anacute angle. When a special gynaecological couch, or operating table,is used the examiner stands between the patients knees as in Fig. 74 ; 120 GYNECOLOGY it is equally convenient, however, for the examiner to stand at theside of the couch, passing his right hand beneath the bent right kneeof the patient {see Fig. 75), and for this method no special couchis required. The right hand is usually employed for the internalexamination, the left is placed upon the hypogastrium, and withthe fingers of the two hands working in conjunction, the pelvic organs ^ ^. / ? I Fig. 74. Method of Making the Bimanual Examination, the examinerstanding at the end of the couch. (From a photograph.) can be palpated simultaneously from above and from below. It isadvisable to become familiar with the use of either hand internally,for the right side of the pelvis can be explored more thoroughly withthe right hand, the left side with the left hand. The examinationshould also be learned in both positions shown in Figs. 74 and 75 ;for the use of a couch or operating table is not always practicable,and in the case of patients confined to bed the position shown inFig. 75 is more convenient and occasions less distress than the other. The body of the uterus is first to be identified, and it is naturallyfirst sought in its normal position of anteversion. The uterus usuallylies roughly in the obstetric axis of the pelvic cavity. In thin subjectsit will be readily felt in this position ; if not found at once, the vaginal VAGIN
Size: 1483px × 1684px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
