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In his earlier papers describing his method of examining the female bladder, Dr. Howard Kelly recommended that the necessary elevation of the pelvis be obtained by placing pillows under the hips as the patient lay on a flat table in the lithotomy position. More recently he has advocated the genupectoral posture as more advantageous.
Each of these methods has certain disadvantages. When the first posture is adopted, the examination is frequently unsatisfactory. The elevation necessarily leads to a flexing of the upper part of the abdomen on itself. This interferes with the free descent of the intestines toward the diphragm, which is necessary to the complete distension of the bladder with air. The hips can not be raised much above twelve or fourteen inches without discomfort to the patient if she be not anesthetized, and if an anesthetic be employed, the cramping of the abdomen interferes with free respiration. In
WEBSTER JC. AN IMPROVED METHOD OF EXAMINING THE FEMALE BLADDER.. JAMA. 1902;XXXVIII(20):1299–1300. doi:10.1001/jama.1902.62480200013001d
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