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 . Fig. 62.—Thomas modified Sims speculum. the vagina, is the forcible contraction by the patient of the perineo-vaginalmuscles, and the pressing down of the anterior vaginal wall. Gentleness andpersuasion will soon overcome this. In stout women, a broader and shorterspeculum is required to expand the vagina thoroughly, and bring the cer-vix nearer the orifice. If the vaginal walls are very flabby and foldy,some difficul
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 . Fig. 62.—Thomas modified Sims speculum. the vagina, is the forcible contraction by the patient of the perineo-vaginalmuscles, and the pressing down of the anterior vaginal wall. Gentleness andpersuasion will soon overcome this. In stout women, a broader and shorterspeculum is required to expand the vagina thoroughly, and bring the cer-vix nearer the orifice. If the vaginal walls are very flabby and foldy,some difficulty may be experienced in preventing them from obstructing theview of the cervix; a short, broad speculum, a large depressor, and down-. PiG. 63.—Emmets modified Sims speculum. ward traction with the tenaculum will generally overcome this. If neces-sary, the examination may be made in the knee-chest position, and willthen always be successful. Modifications and combinations of the Sims speculum.—Besides theminor modifications represented in Figs. 45 to 47, numerous other con-trivances have been adapted to Sims speculum, all with the view of3 82 A TREATISE ON MINOR SURGICAL GYNECOLOGY. supplying- the place of an assistant. Of these the most simple is that ofThomas, the attached sliding- depressor of which is intended to free theright hand; but I have found the breadth of the blade at the angle, andthe shank holding the depressor, entirely insufficient to prevent the over-lapping of the superior natis, and the view therefore quite as much ob-
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Keywords: ., bookcentury1800, bookdecade1880, bookpubli, booksubjectgynecology
