A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Science
A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Medicine -- Practice
[Footnote 6: The left-hand method of examination is incomparably
superior to the right. The palmar surface of the index finger is more
easily directed toward the left side of the pelvis, which is especially
subject to disease. Its tactile sense is more acute and more easily
educated. The stronger right hand should be free to palpate the surface
of the abdomen in conjoined manipulation.]
In exploring the uterine cavity to learn its position the fine
silver-wire probe of Emmet--not the sound--should be used. The uterus,
if freely movable, is liable to be thrown out of its accustomed
position by the heavier, unyielding sound. The sound also causes much
more pain and exposes the patient to great danger of cellulitis. The
frequent lighting and relighting of pelvic inflammation by injudicious
slight manipulations of the uterus doubtless led Emmet to the utterance
of a prophecy which ought to become classical: "A great advance in the
treatment of the diseases of women will be made whenever practitioners
become so impressed with the significance of cellulitis as to apprehend
its existence in every case. The successful operator in this branch of
surgery will always be on the lookout for the existence of cellulitis,
and take measures to guard against its occurrence."
When the probe or the sound is used without the speculum, the patient
{153} should be on the back and the index finger of the left hand
should be used as a guide. The bivalve and cylindrical specula are
almost useless in explorations of the interior of the uterus. The
exploration is most effectually and gently made with Sims's speculum,
the patient being in the left latero-prone position. In some cases the
probe cannot be passed by any other method.
Ascent of the Uterus.
This mal-location may result from traction above or from pressure
below. The organ may be drawn upward and backward by shortening of the
utero-sacral ligaments, which results from inflammation and which
usually induces a troublesome form of anteflexion. The enlarged
pregnant uterus sometimes becomes attached by adhesive inflammation to
a portion of the peritoneum in one of the higher zones of the pelvis or
in the abdomen, and the organ may consequently remain fixed in its
elevated position after involution. A tumor connected with the uterus
or its appendages which has grown too large to be retained in the
pelvis may, upon rising into the abdomen, drag the uterus with it.
Pressure below may come from excessive distension of the rectum or
bladder, or from a large accumulation of menstrual fluid in the vagina,
or from a tumor originating in any portion of the pelvis below the
level of the uterus. In diagnosis, prognosis, and treatment this
displacement is wholly subordinate to the more significant lesions of
which it is only the incidental result.
Retro-location of the Uterus.
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