Identifier: treatiseongync00pozz (find matches)
Title: Treatise on gynæcology : medical and surgical
Year: 1891 (1890s)
Authors: Pozzi, S. (Samuel Jean), 1846-1918 Wells, Brooks H. (Brooks Hughes), b. 1859
Subjects: Gynecology Genital Diseases, Female
Publisher: New York : W. Wood
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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hultz39 in a recent review, I will simply try to give an idea of thetechnique of these two skilled gynaecologists. Reversing the chronological order for the logical, I will describeSangers method. A. Palpation of the Ureters.—The anatomical relations of theseducts with the cervix and vagina have been studied with especialrare of late because of their importance to the success of certain oper- METHODS OF GYNAECOLOGICAL EXAMINATION. 121 utions which, have become the order of the day.40 As is well known,it is possible to feel through the vagina the anterior pelvic portionof the ureters, if injected, in the cadaver, just where they open into thebladder at the base of the broad ligaments; this is equal to a lengthof 6 or 7 cm. (2£ in.), that is, the greater part of the ureters within thepelvis and about one-fourth of their whole length. In pregnant womenwe can feel as much as 10 cm. (4 in.), owing to the general muscularhypertrophy which all the pelvic organs undergo at that time. More-
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Fig. 86.—The Portion of the Ureters Accessible to Touch. 0Hgure diagrammatic; the posteriorvaginal wall supposed to be removed and the ureters visible through the anterior wall.) a, Base of broadligament; b, ureter; c, cervix; d, ligament between the ureters; e, trigonum ; /, urethra; g, vagina. over, one can take his supporting point from the head of the foetusand feel the ureter against that structure. In some cases of gonorrhceal and calculous inflammation of theureters, Sanger was able to diagnose by touch that they wTere remark-ably enlarged. Where there is a chronic inflammation of the broadligament the ureter is found to be very large and palpable upon theother side, as if from hypertrophy. Under Sangers direction I havebeen able to touch the ureters in pregnant women, but on attemptingto repeat it at several different times, the result has always seemed 122 CLINICAL AND OPERATIVE GYNAECOLOGY. uncertain to me. Probably by reason of the great difficulty, and thedoubtfulness of

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