Outlines of the diseases of women / by John Phillips.

  • Phillips, John.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Outlines of the diseases of women / by John Phillips. Source: Wellcome Collection.

    64/332 (page 44)
    here. Too frequent and habitual use of the sound cannot be sufficiently deprecated, and it will be found that as the practitioner becomes more skilled in the bimanual examination, his resort to the sound as an instrument of diagnosis will become correspond- ingly less frequent. It is the author's experience that the majority of ordinary female pelvic ailments can be diagnosed without its use. Circumstances under which the Sound should never be Passed.—(i) During an ordinary and normal catamenial period. (2) Where a history of recent pelvic peritonitis or cellulitis has been obtained. (3) If, in addition to the above, either both or one ovary is tender and fixed, or prolapsed into Douglas's pouch. (4) If malignant disease of the uterine body or cervix be present. (5) If there is a history of the missing of a period. This is open to one exception—viz., when an ectopic gestation is suspected, and a knowlege of the size of the uterus is absolutely essential to make a correct diagnosis. Facts learned by the Use of the Sound.—(1) The length of the uterine cavity. (2) The direction of the uterine axis—forward, backwards, or to one side. (3) The relation of the axis of the body to that of the cervix— anteflexion, retroflexion, lateriflexion. (4) The condition of the endometrium—whether roughened or smooth. (5) Whether any pain is produced by the passage of the bulb of the sound through the external or internal os uteri or by pressure at the fundus, as in metritis and endometritis. Should there be difficulty in withdrawing the bulbous end through the internal os uteri, the presence of stenosis at that site is indicated. (6) Whether the uterus is mobile or not. (7) Whether a tumour presenting at the external os uteri is a polypus or an inverted fundus. How to Pass the Sound.—Before passing this instrument it must be remembered that it may carry on its surface into the uterine cavity septic matter from a previous case. It is necessary therefore to thoroughly disinfect it. This is best done by passing it three or four times slowly through the flame of a spirit lamp, or by holding it a few seconds in a 1 in 20 solution of carbolic acid. When possible, especially if a purulent or offensive dis- charge is present, administer an antiseptic douche.* The index-finger of the right hand should be passed into the vagina, up to the anterior lip of the cervix: the sound is * The vagina of the healthy female should be considered as an aseptic cavity.