. The diagnosis and treatment of diseases of women. e of: Posterior Part of Pelvic Cavity—tenderness, induration, mass; Anterior Part of Pelvic Cavity—tenderness, induration, mass; Ureteral Regions—tenderness, induration, mass; Pelvic Nerve Trunks—tenderness; Lower Abdomen—tenderness, tension, induration, mass. If a mass is found, determine as accurately as possible its position, size, shape,consistency, tenderness, mobility and attachments. 64 THE PHYSICAL EXAMINATION The method of determining whether a mass is attached to the uterus, and if so,how intimately, is shown in Figs. 84 and 85, whe
. The diagnosis and treatment of diseases of women. e of: Posterior Part of Pelvic Cavity—tenderness, induration, mass; Anterior Part of Pelvic Cavity—tenderness, induration, mass; Ureteral Regions—tenderness, induration, mass; Pelvic Nerve Trunks—tenderness; Lower Abdomen—tenderness, tension, induration, mass. If a mass is found, determine as accurately as possible its position, size, shape,consistency, tenderness, mobility and attachments. 64 THE PHYSICAL EXAMINATION The method of determining whether a mass is attached to the uterus, and if so,how intimately, is shown in Figs. 84 and 85, where the sulcus between the uterusand the mass is being palpated to determine its depth. In the case of a tumor witha long pedicle, it is well to have an assistant hold the tumor up in the abdomen outof the way, while the examiner, by bimanual palpation, feels whether or not thereis any connection with the uterus or appendages. Also the uterus may be caughtwith a tenaculum forceps, and pulled downward (Fig. 103), assisting still further in. Fig. 80. A view from another direction, sliowing the marked depression of tlie abdominal wall in deep pelvicpalpation. palpation. Another point is that, in the case of abroad attachment to the uterus,the mass and uterus move as one body, whereas with a long attachment, the twomay be moved separately. In palpating the anterior part of the pelvis, if the body of the uterus is not felt infront and still the vaginal and abdominal fingers cannot be brought well together,have the patient pass the urine, and then examine again. If the patient cannoturinate, or does not seem to empty the bladder well, she may be catheterized. Aspontaneous urination in the upright posture empties the bladder better, and issafer than catheterization, which may be followed by cystitis. A partly filledbladder is not felt as a distinct mass and yet there may be a half a pint or more ofurine—enough to make the palpation very unsatisfactory. The peculiar thing DI
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