Identifier: diseasesofkidney01kell (find matches)
Title: Diseases of the kidneys, ureters and bladder, with special reference to the diseases of women
Year: 1922 (1920s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943 Brödel, Max, 1870-1941 Burnam, Curtis Field, 1877-
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Publisher: New York, London : D. Appleton and company

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lamed, hardened ducts of Skenesglands. When affected in this way by chronic gonorrheal inflammation they arevery mnch like the in-flamed, hard Bartho-lins ducts in thelabia. On squeezingone of these glands ina direction from abovedownward in chronicgonorrheal cases adrop of pus can bemade to exude (Fig.114). One must notmistake for this con-dition the whitish,inspissated materialmade up simply of ac-cumulated debris re-sulting from the shed-ding of the glandularepithelium which notinfrequently accumu-lates to a great extent.The urethra itself,about 3 cm. in lengthand firmly adherent tothe vaginal mucosa, iseasily rolled from sideto side under the fin-ger. Any enlargementof the urethra, due tocancerous infiltration,is at once recognizedby the increase in sizeand density. If thereis a suburethral ab-scess this forms a cushiony enlargement the size of a hazel nut or smaller andcan be emptied by pressure (Fig. 620). In examining the vesico-iirethral portion of the urinary tract one should
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Fig. 114.—Milking the Urethra to Express Pus fromSkenes Ducts. 240 EXAMINATION OF THE URINARY TRACT IN WOMEN. always notice any marked tendency to descensus, due to a lack of support at thepelvic floor, with a relaxation of the structures above, allowing the bladder andurethra to roll downward and outward, changing entirely the direction of thedischarge of the urine and the act of voiding with any straining. The Vesical Tract Examined by Palpation to DetermineAny Enlargement or Unusual Sensitivenes s.—The bladder isexamined, as a rule, in an empty state, when the fingers can be brought closetogether and all parts of the bladder can be touched with the vaginal finger andpressed upon bimanually without causing pain or sensation of any kind. If thebladder is inflamed the patient will often complain of pain, which may be local-ized on one side or the other, or posteriorly. If infiltrated or enlarged so that itswalls are as much as 1 em. in thickness, even when emptied of its urine, it

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