Modern surgery, general and operative . Fig- 775-—Examination of the rectimi by reflected light (Kelly). patient is placed in the knee-chest position. A tube containing an obtu-rator is well greased with vaselin. The buttocks are drawn apart, andthe blunt end of the obturator is laid on the anus, which is als^ coated with Examination of the Anus and Rectum 1169 vaselin. The direction of the instrument should be first downward andforward, and, when the sphincter is well passed, up under the sacral promon-. Fig. 776.—^Kellys rectal specula. tory. The moment the speculimi clears the sphincter ani
Modern surgery, general and operative . Fig- 775-—Examination of the rectimi by reflected light (Kelly). patient is placed in the knee-chest position. A tube containing an obtu-rator is well greased with vaselin. The buttocks are drawn apart, andthe blunt end of the obturator is laid on the anus, which is als^ coated with Examination of the Anus and Rectum 1169 vaselin. The direction of the instrument should be first downward andforward, and, when the sphincter is well passed, up under the sacral promon-. Fig. 776.—^Kellys rectal specula. tory. The moment the speculimi clears the sphincter ani and the obturatoris withdrawn, air rushes in audibly and distends the bowel. When the enter-ing instrument is pressedgently against the sphinctera sharp muscular contractionensues. If the instrument isgently and sHghtly with-drawn, relaxation occurs, andthe moment of relaxationmay be seized to make anentry. An entry so made israpid and unresisted. Thebowxl being distended withair, the mucous membraneis plainly seen as the tubeis slowly withdrawn and theelectric light is reflected intothe speculimi by a foreheadmirror. The normal mucousmembrane is dull red, likethe nasal mucosa, and theblood-vessels are plainly dis-tinguishable. The Kelly tubemust be used with greatcare, as harm may be doneby it, and the longest tubeshould be used only in excep-tional cases. I use ^\ith the greatest satisfaction James P. Tuttles pneumatic proc-toscope (Fig. 777). Dr. Tuttle describes it as follows (Diseases of t
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
