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.

    69/332 (page 49)
    What is to be observed through Sims's Speculum.—(i) The cervix, whether lacerated or entire; whether the os uteri is a small trans- verse slit or pin-hole ; whether any granular erosion,_ specific or malignant ulcer, or villous growth occupies any portion ot it. Small globular yellowish bodies may be seen projecting from be- neath the surface: these are Nabothian follicles, and are due to obstructed and dilated cervical glands. (2) The nature of the discharge, whether glutinous or liquid, clear or opalescent, blood-stained or not. (3) The colour of the cervix, whether violet, red, or pale pink. (4) The whole of the anterior wall of the vagina. The amount of rugosity and violet discoloration, if present. (5) The condition of the orifice of the urethra; whether pus can be expressed from it; whether the lips are red and everted, or if the orifice is occupied by a urethral caruncle. It would be here advisable, in case the sound could not have been passed with previous trials, to attempt to pass it with the speculum in situ, the anterior Up being steadied by the application of a tenaculum. (6) The anterior fornix can be seen descending and ascending with inspiration and expiration. (7) Should the patient have complained during examination, of a painful spot on the posterior vaginal surface, the speculum may be rotated without, difficulty, the anterior wall retracted and the posterior brought into view. The Advantages of Sims's Speculum—(1) The cervix is seen as it exists, especially if lacerated. (2) For operations on the cervix and vagina it is an absolute necessity. (3) Introduction of the blade and retraction of the perineum is almost a painless proceeding. Supposed Disadvantage.—That a skilled assistant is required ; but it has been found that with an ordinary nurse to raise the right buttock and steady the tenaculum, the operator holding the speculum, no other assistance is required. (iii.) Neugebauer's Speculum.—This is a divided Sims's, the anterior and smaller blade fitting into the larger posterior one. (Fig. 38.) How to Use Neugebauer's Speculum.—The larger blade, being warmed and oiled, is introduced exactly as a Sims's speculum, and held by the left hand. The patient now raises her right thigh and the smaller blade is passed into the vagina along its anterior wall, fitting into the larger blade, the operator's forearm resting between the two thighs. This is a self-retaining speculum, and by approximating the handles, stretching of the anterior and