A Text-book of Diseases of WomenPenrose, Charles B. (Charles Bingham)
Science
A Text-book of Diseases of Women
Penrose, Charles B. (Charles Bingham)
Women -- Diseases
By the method of examination here advised the physician will always
make a visual examination before making a digital one. There are
several advantages derived from this procedure. In the first place, no
examination of a woman is thorough unless a careful visual examination
of the external genitals has been made. The discovery of discharges
and of lesions of the external genitals may throw much light upon
the condition found higher up in the pelvis. Again, the examiner
protects himself. A great many unfortunate cases of syphilis have been
acquired by physicians from a primary sore upon the examining finger.
A preliminary visual examination enables one to guard against this
danger. The primary sore occurs upon the end of the examining finger or
upon the web between the index and middle fingers--the part of the hand
that is pressed against the fourchette.
The hands of the physician should, of course, be surgically clean
before making an examination, and the grease or oil which is used
as a lubricant should be clean. The hands should always be washed,
after separating the parts to make the visual examination, before the
finger is thrust into the vessel containing the lubricant. It is best
to place a small portion of the lubricant on a plate or a saucer for
each individual patient, and thus avoid the danger of contaminating
the rest. Carbolized oil, borated vaseline or cosmoline, and a thick
sterile solution of soap are good lubricants. Neutral green soap
diluted with boiled water to the consistency of thin jelly is a very
agreeable lubricant which may easily be washed from the hands and the
vagina.
If practicable, the woman should receive a vaginal douche of
bichloride-of-mercury solution, 1:4000, and the vulva should be
washed, before making a bimanual examination. The examiner should
always clean the external genitals of all discharges before introducing
the vaginal finger. In this way we avoid the danger of carrying septic
material from the external genitals to the upper portion of the genital
tract. This preliminary cleansing is not desirable before the external
genitals have been examined; for much may be learned from observation
of the discharges which bathe or escape from the various structures.
If practicable, a cleansing vaginal douche of bichloride-of-mercury
solution should be administered after the bimanual examination.
[Illustration: FIG. 4.--Double tenaculum.]
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