Outlines of the diseases of women / by John Phillips.

  • Phillips, John.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Outlines of the diseases of women / by John Phillips. Source: Wellcome Collection.

    60/332 (page 40)
    internal labia are pendulous, one or both may be pushed in front of the finger and so obstruct the orifice. The vulval opening may be patulous, as after recent labour, or from a lacerated perineum, or it may be narrow and examination difficult. (b) Vagina.—The finger now passes backwards and upwards, and notes the condition of the mucous membrane of the vagina, whether moist or dry, hot or cool, smooth or rugose (wrinkled) ; whether the anterior wall is tender, as in acute or chronic cystitis, or the posterior wall, as in inflammation of the rectum (proctitis). The vagina is usually contracted and short in old women. Presence or the reverse of cicatricial tissue must be noted. Foreign bodies in the vagina—e.g., pessaries of vulcanite, india-rubber, or glass, and a variety of others may be found occupying the vaginal cavity. Notice whether any growth is projecting into the vaginal roof, or if the mucous membrane is covered with raised papules or nodules which may sometimes indicate the presence of sarcoma. As the finger travels still further backwards, the cervix will be found projecting more or less from the vaginal roof. Notice whether it is centrally placed or whether laterally displaced. In front and behind this are the anterior and posterior cul-de-sacs: observe the depth of these, and whether occupied by any solid mass. Scybalse in the rectum may so encroach on the vaginal cavity as to make an enema necessary before a satisfactory examination can be carried out. (c) Cervix.—Note the length of the vaginal portion of the cervix—i.e., how much it projects into the vaginal cavity; whether it is conical and long, or short and obtuse. Notice the direction in which the external os uteri points, whether forward, back- ward, or laterally. The normal direction is downwards and backwards, and nearly at right angles to the plane of the inlet of the pelvis. To the touch it somewhat resembles nasal cartilage. The External Os Uteri: whether soft or hard, smooth or irregular, patulous (open) or closed. In healthy nulliparous women its shape and size cannot be made out by touch alone: it conveys to the examiner the idea of a shallow concavity ; but in a multipara the aperture may be about half an inch across, and admit the tip of the finger easily. In women who have passed through an artificial or natural menopause, the vaginal portion of the cervix tends to atrophy, and what was formerly a projection becomes nearly flush with the vaginal roof. Remark if any mass is presenting at the external os uteri, as a cervical polypus or malignant growth. Cervical Lacerations.—These are the result of normal labour, or of one which may have been too rapid, or the forceps applied before complete thinning and dilatation of the cervical tissue has