. Clinical gyncology, medical and surgical. the vagina and pressure is made on the posterior vagi-nal wall backward and outward towards the amis. It is asthough one were trying to push the finger through the pos-terior vaginal wall out of the anal orifice. (Fig. 41.) Theeffect is to expose the lower segment of the rectum, especiallyanteriorly. For any but the lowest part of the rectum a speculum isnecessary. The best rectal speculum for the lower rectum isIvess (Fig. 42), of which there are three sizes, the largestbeing the best for general use. For the inspection of the higher rectum ether is
. Clinical gyncology, medical and surgical. the vagina and pressure is made on the posterior vagi-nal wall backward and outward towards the amis. It is asthough one were trying to push the finger through the pos-terior vaginal wall out of the anal orifice. (Fig. 41.) Theeffect is to expose the lower segment of the rectum, especiallyanteriorly. For any but the lowest part of the rectum a speculum isnecessary. The best rectal speculum for the lower rectum isIvess (Fig. 42), of which there are three sizes, the largestbeing the best for general use. For the inspection of the higher rectum ether is usuallynecessary, as most instruments require forcible stretching ofthe sphincter ani. Simss speculum may be used, and in many cases is avery satisfactory instrument. It is better to give ether, but it may be used Kellys ureteralcatheter. METHODS OF GYNAECOLOGICAL EXAMINATION. 71 without. The patient should bo placed in an exaggerated Sirass position,—that is, the hips should be raised higher than usual. Some exaniining-tables Fig. Digital eversion of the rectum. provide for this. Where they do not, a pillow may be placed under the hipsand the same result attained. The speculum, well lubri- FlG- cated, is then slowly passedin and the posterior wall re-tracted just as in the vaginalexamination. The air entersand balloons the rectum, andtwo-thirds of the circumfer-ence of the bowels can be well seen. Traction on the Ivess rectal speculum, anterior wall will expose theposterior wall, but not so well. Illumination can be obtained by reflected
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