Identifier: operativegynecol001kell (find matches)
Title: Operative gynecology :
Year: 1906 (1900s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943
Subjects: Gynecology Gynecology Gynecologic Surgical Procedures
Publisher: New York and London : D. Appleton and company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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it may be either more orless. I have often seen it upon simply carry-ing the speculum straight into the bladderwithout deviating more than from three tofive degrees to the right or left. I use asimple device, figured in the text as a goni-ometer (see Fig. 278), to measure the angle between a line connecting theureteral orifice with the internal orifice of the urethra and the axis of theurethra. The zero line of the goniometer is held in the line of the urethrawhile the long arm points to the ureteral orifice, when the angle can be readoff on the graduated arc. In inflammatory cases the ureter is often drawnmarkedly to one side. If the abdomen is filled with ascitic fluid, or if there is a tumor wedgedm the pelvis, or if inflammatory disease is present, the bladder may not dis-tend enough to allow the ureteral orifices to be seen. In such cases the orificemay be sought in the dorsal position without elevation. The ureteral orifice is recognized as soon as it comes into the field of the
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Fig. 278.—Using the Goniometer todetermine the angle made by theAxis of the Urethra, with a Line DRAWN FROM THE INTERNAL URE-THRAL Orifice to the Ureter. 492 AFFECTIONS OF THE URETEBS. speculum as a fine transverse slit, 2 to 3 mm. long, like a little dark line onthe bladder wall, not unlike a water mark in paper. At times it appears moredistinct, owing to a slight injection of its borders. Rarely it looks like a finedark point or a distinct hole. In the knee-chest position a decided eminence,having the form of a truncated cone, marks its site, and the opening is situatedon top or on the anterior urethral side of this. I have called this elevation >*

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