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OPERATIVE SURGERY ON THE CADAVER.
USE OF SPECULA, CATHETERS, SOUNDS, BOUGIES, AND
PLUGGING OF POSTERIOR NARES.
I. INTRODUCTION OF AURAL, NASAL, VAGINAL, AND
Aural Speculum (Gruber, Toynbee).—Before the speculum can be introduced, the canal must be straightened by seizing the auricle by its upper part and drawing it upward, backward, and outward.
Moisten the speculum with water, and gently insert the small end into the canal. The speculum is to be introduced into the canal to the required extent by gently screwing it forward and backward in a small arc, and by slight pressure.
To examine the drum, it is best to use reflected light. The speculum must be manipulated to bring the different parts of the canal and of the drum into view.
An ear-syringe must have its nozzle introduced in the same manner as the speculum. Apply the nozzle to the roof of the canal while injecting the fluid.
Nasal Speculum (Fraenkel).-Insert the speculum along the floor of the naris, having first pushed up the tip of the nose to straighten the canal. The floor of the naris extends horizontally backward.
When the speculum has been introduced to the extent of one to one and a half inch, the blades are to be separated by the screw.
Both nostrils may be dilated at once by putting one blade of the speculum on each side of the septum, and then separating them.
Vaginal Speculum (Fergusson, Sims).—Place the subject on the back, with the hip-joints and knees semiflexed and the thighs separated, in order to use the ordinary specula. Lubricate the cylindrical speculum (Fergusson). Press the posterior edge of the vaginal entrance downward with the convex side of the tip of the instrument. Push the speculum hori. zontally to examine the canal and manipulate to bring into view the cervix.
Place the subject on the left side with the left arm drawn posteriorly so that she rests upon the left chest-wall; flex the thighs and legs to about a right angle. The right knee rests above the left, so that the right hip-joint is more flexed than the left. Lubricate the blade of Sims's speculum which is to be introduced. Grasp the isthmus of the instrument between the fingers and thumb of the left hand, and let the blade to be introduced rest in the concavity of the extended thumb and index-finger of the right hand with the pulp of the index-finger extending beyond the lip of the instrument. The right forefinger is thus in the concavity of the blade to be introduced. Press against the posterior wall of the vagina with the back of the right index-finger and guide the blade into the vagina with the convexity toward its
posterior and superior lateral wall. The walls of the vagina are separated, allowing air to distend the canal.
To hold the speculum, the assistant must stand behind the body and use the width of his hand like a wedge between the buttock and upper blade of the speculum. The isthmus lies against the palm of the hand, and the superior part between the index-finger and thumb, leaving the other fingers free.
An instrument to depress the vaginal folds obstructing the view
may Rectal Speculum.—Place the subject on the back with the thighs separated; or on the side with the knees pushed up close to the abdomen. A reflecting cylindrical speculum with a portion of its circumference deficient, or one of the valve specula, may be used. Lubricate the point of the instrument. Insert, directing the point of the instrument toward the bladder, hence somewhat forward, for the first inch and a half. Now the point of the instrument is to be directed nearly horizontally backward, toward the hollow of the sacrum.
If a valve-speculum is used, it is to be opened, after it is fully introduced, and again shut before beginning to be removed. Manipulate the speculum to bring into view every part.
The nozzle of a syringe must follow this same course during its introduction.
II. CATHETERIZATION OF EUSTACHIAN TUBE, NASAL DUCT;
INTUBATION OF TRACHEA; USE OF STOMACH-TUBE,
Eustachian Catheter (Noyes).—Pass the catheter, keeping its point against the floor of the naris until