File:Operative gynecology - (1906) (14760576166).jpg

Identifier: operativegynecol001kell (find matches)
Title: Operative gynecology :
Year: 1906 (1900s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943
Subjects: Gynecology Gynecology Gynecologic Surgical Procedures
Publisher: New York and London : D. Appleton and company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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. I have never seen any seriousbleeding nor have had to treat the ruptures later as fissures; only two or threetimes have I had to put in a fine suture to stop the oozing. An unusuallysmall and rigid orifice should be cut posteriorly, as suggested by Simon; then,after the examination, the cut is closed with one or two fine silk sutures. Introducing the Speculum.—A skillful examiner will select a suit-able speculum (Fig. 216, p. 357), a No. 7, 8, 9, or 10, or one of the half sizes between, according tothe case, the age of the pa-tient, and the purpose of theexamination; a patient witha sensitive urethra may oftenbe treated with less discom-fort and with equal facilitythrough a No. 7~; or 8 specu-lum. The smaller sizes arebetter adapted to girls andto young women with smallurethrac. Beginners in cys-toscopy are apt to select alarger speculum, using always a No. 10 or 11; with experience they will drop asize or two. To introduce the speculum, it is grasped as shown in Fig. 223, and the
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Fig. 223.—Holding the Vesical Speculum ready forIntroduction; the Thumb presses the Obturatorfirmly IN. TECHNIQUE OF THE EXAMINATION. 363 obturator is kept from slipping back into the cylinder by a decided pressurewith the thumb, continued until the end has entered into the bladder. Theurethra, wiped clean with a boric acid solution, is exposed by an assistantholding the buttocks and the labia well apart, while the point of the speculum,coated with the boroglycerid solution, is applied to the urethral orifice, andpushed through the urethra into the bladder with a gentle sweep around thepubic arch. The handle of the speculum is now firmly grasped, while theobturator is withdrawn with a slight rotary motion. If the internal urethralorifice is drawn well into the pelvis by the posture, the urethra is so muchcurved that there is danger of injuring it by pushing the speculum hardagainst its posterior wall; this must be avoided by introducing the speculum

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