Minor surgical gynecology : a manual of uterine diagnosis and the lesser technicalities of gynecological practice : for the use of the advanced student and general practitioner . is desirable to see or reach the right upper portion ofthe vagina, as in fistulte in that region, or the aspiration of cellulitic ab-scesses in the right broad ligament, this position is preferable to the the knee-chest position, the Sims speculum is also a very useful in-strument. By lifting the perineum with it, air and light are admitted intothe vagina, which is distended balloon-like, every fold and crevic
Minor surgical gynecology : a manual of uterine diagnosis and the lesser technicalities of gynecological practice : for the use of the advanced student and general practitioner . is desirable to see or reach the right upper portion ofthe vagina, as in fistulte in that region, or the aspiration of cellulitic ab-scesses in the right broad ligament, this position is preferable to the the knee-chest position, the Sims speculum is also a very useful in-strument. By lifting the perineum with it, air and light are admitted intothe vagina, which is distended balloon-like, every fold and crevice becom-ing effaced. A better view of vagina and cervix are obtained in this man-ner than even in the semiorone position; the objection to the knee-chestposition is its inconvenience to the patient, and consequent unsuitablenessfor long examinations. The speculum is simply slipped into the vaginasideways, turned, and its shank grasped by one full hand, which makesstrong upward traction, while the forearm rests on the sacrum as a ful-crum. Depressor and tenaculum are generally not needed to expose thecervix. In stout women, it is usually necessary to separate the nates be-. Fig. 61.—Expansion of vagina. Position of uterus and speculum in the knee-chest position. (Hegar andKaltenbach.) fore obtaining a full view. An examination in this position may be advis-able when it is desired to obtain a view of the distended vagina (fistula,_vaginitis); it is chiefly employed as a preparatory step to replacing aretro-displaced uterus (see Figs. 214 and 215), or introducing a pessary, oroperating on a vesico-vaginal fistula. In case of emergency, the two first fingers of the right hand may beused as a substitute for the duckbill speculum, and a view of vagina andcervix be obtained, or tampons introduced or removed by their aid in semi-prone and knee-chest positions. The difficulties encountered in making a specular examination are chieflysuch as are due to the presence of the hymen, or con
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Keywords: ., bookcentury1800, bookdecade1880, bookpubli, booksubjectgynecology
