. Clinical gyncology, medical and surgical. uttock asa point of resistance, the finger can be so rotated that its palmar surface Position of examining hand. METHODS OF GYNAECOLOGICAL EXAMINATION. 37 will be directed upward and the whole vaginal vault can be reached andpalpated, even the right side, though naturally less perfectly than the reversing the hands, as will be spoken of later, the examination canbe made thorough. Practice will so increase the flexibility of the indexfinger at the metacarpophalangeal joint that this method will become moreand more easy. Certain facts can be as
. Clinical gyncology, medical and surgical. uttock asa point of resistance, the finger can be so rotated that its palmar surface Position of examining hand. METHODS OF GYNAECOLOGICAL EXAMINATION. 37 will be directed upward and the whole vaginal vault can be reached andpalpated, even the right side, though naturally less perfectly than the reversing the hands, as will be spoken of later, the examination canbe made thorough. Practice will so increase the flexibility of the indexfinger at the metacarpophalangeal joint that this method will become moreand more easy. Certain facts can be ascertained by the examining finger alone. Thecondition of the perineum can be told in a general way, though its exactstatus can be determined only by visual inspection. The shape and lengthof the vagina and the condition of its walls can be approximately made outand valuable inferences drawn. Unusual dryness or heat of the vagina,excessive development or absence of the rugae, and the presence of swellingsor cicatrices, may be quickly Relation of axis of normal uterus to that of the vagina. Palpation of the Cervix.—At the upper end of the vagina, projectingto a greater or less extent into its lumen, is felt the cervix uteri. Its normalshape is conical, with an opening at its extremity. It is easily distinguishedfrom the surrounding vaginal walls by its greater hardness. It may varywithin normal limits in length and shape and in the size of the os may also be very markedly changed by parturition and by disease, so ;i-to present a variety of forms. It softens as a result of pregnancy, so thatin the later stages it can hardly be distinguished from the walls of thevagina; to a less degree as the result of profuse hemorrhages. It grows 38 METHODS OF GYNAECOLOGICAL EXAMINATION. hard from cicatricial contraction following lacerations at labor and as aresult of chronic inflammatory processes. Normal Position of the Cervix.—The normal position of the cervix is with it
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