. Diseases of women. A clinical guide to their diagnosis and treatment. teverted, but much oftener retroverted. Thereis now no longer pulling of the cervix from the fundus, andtherefore the cervix is not elongated; the uterus becomesagain its normal length. The cervix is no longer constrictedby being encircled by the vulva, and therefore the swelling ofthe cervix, which was the result of the constriction, ulceration and the dry scaly condition of the vaginal andcervical mucous membrane are the same. Diagnosis.— Uterine prolapse of the first degree is recog-nised by the descent o
. Diseases of women. A clinical guide to their diagnosis and treatment. teverted, but much oftener retroverted. Thereis now no longer pulling of the cervix from the fundus, andtherefore the cervix is not elongated; the uterus becomesagain its normal length. The cervix is no longer constrictedby being encircled by the vulva, and therefore the swelling ofthe cervix, which was the result of the constriction, ulceration and the dry scaly condition of the vaginal andcervical mucous membrane are the same. Diagnosis.— Uterine prolapse of the first degree is recog-nised by the descent of the cervix when the patient strains,and the absence of enlargement of the uterus. Ascertainthe size of the uterus by bimanual examination. UTERINE DISPLACEMENTS: PROLAPSE. 123 Uterine prolapse of the second degree, with elongationof the cervix, has to be distinguished from hypertrophy of theinfra-vaginal portion of the cervix. This is a congenitalmalformation occasionally met with in virgins. It generallycauses slight descent. Make the distinction by pushing back. O TT Fig. 33.—Third degree oi prolapse; uterus completely outside vulva; vaginacompletely inverted (If. Barnes). {From a specimen in St. Georges HospitalMuseum.) p, symphysis pubis ; b bladder ; b, cystocele, that is, prolapsed psrt of bladder ; u, urethra ;o u, os uteri ; d, Douglass pouch outside vulva ; o, ovary dragged down ; a, anus. the protruded cervix as far as possible. In prolapse withelongation from the dragging of the vagina, the cervix can bepushed quite back and up until not more than half an inch ofits length protrudes into the vagina. In hypertrophy of theinfra-vaginal cervix, however high the cervix is pushed up,the columnar vaginal portion remains jutting downwards into 124 DISEASES OF WOMEN. the vagina for a length of one to two inches or more(Fig. 35). Uterine prolapse of the third degree can scarcely be takenfor anything else. There is a bag hanging from the vulvacovered with dry scaly mucou
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