Essentials of pelvic diagnosis : with illustrative cases / by E. Stanmore Bishop ; and an appendix on examination of blood, etc. by Chas. H. Melland.

  • Bishop, E. Stanmore.
Date:
1903
Catalogue details

Licence: In copyright

Credit: Essentials of pelvic diagnosis : with illustrative cases / by E. Stanmore Bishop ; and an appendix on examination of blood, etc. by Chas. H. Melland. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    this position is chosen, in order to use the left hand inter- nally the patient must he on the left edge of the bed, and the examiner must sit on the left side. If the patient, as is usual, lies on the right edge, the examiner must use his right hand internally. There is no absolute objection to this if it is preferred ; but it is weU for each man to choose once for all which hand he will use internally, and always use it in the same manner. The time expended in educating each hand so as to be ambidextrous is really wasted, since it might be better expended in educating one, to appreciate small differences in shape, size, and consistence of parts, and their relations to one another. These differences are so infinite, that many years of practice are required before they can be said to be absolutely mastered : and it may truly be said that it is impossible to develop what may be called the sense of sight in the fingers too highly. Ambi-dexterity in operating may be of essential service, but the necessity for it is not apparent in examination. Bi-manual examination is required to detect conditions not recognizable visually, even when assisted by the use of a speculum. It is almost impossible in very fat people, except under anaesthesia. This should be used whenever certainty without it is not attainable. In any of these positions a previous clearing of the rectum by enema is imperative ; the bladder also should have been previously emptied. In the left lateral position, Kelly* has introduced a very valuable preliminary manoeuvre. The patient is first placed in the knee-chest position ; a small speculum or canula is introduced into the anus. Air rushes into the rectum. In about a minute the intestines will be found to have left the pelvis, and the speculum is removed. The patient is then very slowly and cautiously lowered into * Operative Gyncccolo^^y: Kelly, vol. i, p 99.