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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king this posture the patient kneels on a table (Figs.121, 122, 123) or bed under which a broad lap-board has been introduced, withthighs as nearly vertical as possible, and with the chest as nearly as possibletouching the board. It is important to get the pelvis as high as possible, andthe upper or head end of the body as low as possible. To bring the head asclose as may be to the board, the face is turned to one side and the elbowsspread out akimbo. With some patients the distention of the bladder is bettereffected if the thighs are not quite vertical, while the patient tends to fallforward a little; in others the distention is best secured with the patient INSPECTION. 249 squatting a little in the direction of the operator. We cannot sufficiently empha-size the importance of a correct ))()sturc of tlie patient. Almost inv^iriably tliefailures to make a satisfactory examination of the bladder ))rocced from theneglect of this precnutidu. Oiilv in the rarest instances does the bladder
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Fig. 122.—Knee-chest Posture, Lateral View. Note position of arms and head Thechest is brought all the way down to table. The back slightly bent downward. Thediagram above shows variations which help in securing proper dilatation of bladder. refuse to distend with air when the patient is correctly posed, and in such casesdistention can be secured by the administration of an anesthetic, which bringsabout a greater relaxation. Where it is desirable to get a maximum distentionof the bladder it is better to see that the bowels are emptied beforehand, andto avoid making the examination with a full stomach. Once in a while anexcessively stout patient is found who cannot be satisfactorily examined inthis way. Elevated Dorsal Position.—If the patient has recently passedthrough an operation, or is old and feeble and cannot stand the knee-breastposture, she can then be examined in the elevated dorsal position. This is best 250 EXAMINATION OF THE URINARY TRACT IN WOMEN done on a table wliere

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