. The diagnosis, pathology and treatment of diseases of women including the diagnosis of pregnancy. sh it from retro-flexion of the uterus. GENERAL ENLARGEMENT OF THE UTERUS, FROM WHATEVER CAUSE. When the cavity of the uterus is considerably distended by thepresence of a foetus, by a large polypus, or from whatever cause,a tumor may be felt behind or in front of the upper part of thevagina. In cases of pregnancy, the recognition of the presence ofthis tumor is of the greatest possible assistance in establishing thediagnosis. ENLAKGEMENT OF THE UTERUS. 167 We have now to consider the diagnosis
. The diagnosis, pathology and treatment of diseases of women including the diagnosis of pregnancy. sh it from retro-flexion of the uterus. GENERAL ENLARGEMENT OF THE UTERUS, FROM WHATEVER CAUSE. When the cavity of the uterus is considerably distended by thepresence of a foetus, by a large polypus, or from whatever cause,a tumor may be felt behind or in front of the upper part of thevagina. In cases of pregnancy, the recognition of the presence ofthis tumor is of the greatest possible assistance in establishing thediagnosis. ENLAKGEMENT OF THE UTERUS. 167 We have now to consider the diagnosis between enlargements ofthe uterus from whatever cause and other conditions. The deter-mination of the nature of such enhirgement will form a questionfor subsequent consideration. When the tumor felt behind the upper part of the vagina iscaused by an enlarged uterus, as in the case of pregnancy at thethird or fourth month, it is rounded, smooth, and central, there isan evident continuity between the tumor and the cervix, and,moreover, the tumor spreads out behind, to the sides and to the Fig. front of the cervix equally. It is not possible to detect any lineof division, or any depression between the two parts; the cervixconstitutes, in fact, the centre of a rounded symmetrical body, theshape of wdiich, together wdth the absence of irregularities on thesurface, show tliat it can be nothing but the uterus. If a roundedsmooth tumor were felt behind the cervix, and no correspondingenlargement in front of the cervix, the only possible conclusionwould be, either that the tumor felt posteriorly w-as not the uterusat all, or that it was the uterus bent backwards, as described above(p. 162). The question—What is the nature of the enlargement of the 1G8 DIAGNOSIS. uterus ? supposing such to be present—is usually to be resolved bya combined vaginal and abdominal examination. In some fewcases the vaginal examination alone is sufficient. The vaginal ex-amination of the enlarged uteru
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