File:Gynecological diagnosis (1910) (14778025585).jpg

Identifier: gynecologicaldia00burr (find matches)
Title: Gynecological diagnosis
Year: 1910 (1910s)
Authors: Burrage, Walter L. (Walter Lincoln), 1860-1935
Subjects: Women
Publisher: New York, London, D. Appleton and Company
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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metrium and sub-mucous layer is avoid-ed by observing the di-rections already given,and the production ofseptic infection by ob-serving strict asepsisand by not operatingduring acute attacksof pelvic inflamma-tion. Digital Exploration ofthe Uterine Cavity.—This is practiced ordi-narily for complete in-vestigation in cases ofdoubt. The dilatationis effected by means ofthe Hanks dilators, fol-lowed by the Wathendilator. The Bossi uterine dilator or large steel rectal dilators areuseful for the extreme stages of the dilatation. The bare fingershould be employed for the exploration because thus the full ben-efit of the tactile sense is to be obtained. In exceptional cases,those with rigid cervices where danger of rupture of the tissue isgreat, a valuable method of exploring the uterine cavity is thatdescribed most fully in Dr. Howard A. Kellys Operative Gyne-cology, Second Edition, Vol. I., page 596. An anterior colpotomyis performed, the transverse incision being used. After the vagina
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Fig. 38.—Transverse Incision Anterior toCervix. (Kelly.) INSTRUMENTS AND THEIR USE 95 and bladder have been separated from the uterus by blunt dis-section, the cervix is steadied by two vulsella and the anterior lipof the cervix is divided between them with scissors to a pointbeyond the internal os. The digital examination of the uterineinterior completed, the divided uterine walls are brought togetherwith sutures and the vagina is then replaced and sutured. In myexperience, a certain amount of preliminary dilatation of the cervixfacilitates this opera-tion. (See Figs. 38-41.) The remaining in-struments in the ex-aminers kit, namely,those for the investi-gation of the urethra,bladder, and ureters,and those for the ex-amination of the rec-tum, will be describedin the succeeding chap-ters devoted to thesesubjects. Pelvimetry.—Thegynecologist is fre-quently consulted bywomen who wish toknow whether theyhave any pelvic de-formity that would bea hindrance to theirhaving children, alsob

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