. The diagnosis of diseases of women . Bimanual palpation of the prolapsed uterus. attempt to replace the uterus may be made without anaesthesia, butwhere there is much tenderness or where great diflaculty is encoun-tered an anaesthetic should be given. Among hindrances to thereplacement of the uterus may be mentioned pelvic tumors, adhe-sions, inflammatory exudates, and swelling from oedema and indura-tion of the uterus and vagina. While the clinical symptoms cannot be relied upon in the diag- 230 SPECIAL DIAGNOSIS nosis of prolapsus uteri, they are fairly constant and deserve con-sideration.
. The diagnosis of diseases of women . Bimanual palpation of the prolapsed uterus. attempt to replace the uterus may be made without anaesthesia, butwhere there is much tenderness or where great diflaculty is encoun-tered an anaesthetic should be given. Among hindrances to thereplacement of the uterus may be mentioned pelvic tumors, adhe-sions, inflammatory exudates, and swelling from oedema and indura-tion of the uterus and vagina. While the clinical symptoms cannot be relied upon in the diag- 230 SPECIAL DIAGNOSIS nosis of prolapsus uteri, they are fairly constant and deserve con-sideration. Backache is the most common complaint, but is more often dueto diseases of the adnexse and to inflammatory exudates complicatingprolapsus. Feeling of weight, ^pressure, and traction is to be accounted forby the increased size of the uterus, by pressure upon neighboring Fig. 78. Prolapse of the third degree. Uterus protruding through the vulva. Sounds demonstratethe bladder to be in complete descent with the uterus. (Schaffer.) structures, and by traction upon adhesions and the natural supportsof the uterus. Leucorrhoea and menorrhagia are the results of passive congestionof the uterus, which in turn is the result of the displacement. Sterility is due to mechanical hindrances and to complicatinglesions in the uterus and adnexse. Pregnancy in a prolapsed uteruswill either terminate spontaneously or go on to full term. Abortionis most likely to occur about the fourth month, when the pregnant DIAGNOSIS OF MALPOSITIONS OF THE UTERUS 231 uterus can no longer be accommodated in the limited space of thepelvis. If, however, the uterus does rise into the abdominal cavity,the prolapsus is relieved for the period of pregnancy. Involutionin the puerperium is likely to be retarded, and the lochial dischargemay remain bloody an unusually long time. Disturbances of the blad
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