. The diagnosis and treatment of diseases of women. y oran inflammatory mass in the cul de sac or about the tube. The distinguishing characteristics of a fecal mass are three: (a) it is not partic-ularly tender, (b) it has usually a putty-like consistency and may be dented, thedent remaining, and (c) it may sometimes be pushed along to a chfferent position EXAMINATION OF THE CERVIX UTERI 49 in the bowel. In a doubtful case, the bowels should be moved thoroughly bya purgative and the rectum cleared with an enema and the patient againexamined. In a patient with a lax pelvic floor, the anal tissu
. The diagnosis and treatment of diseases of women. y oran inflammatory mass in the cul de sac or about the tube. The distinguishing characteristics of a fecal mass are three: (a) it is not partic-ularly tender, (b) it has usually a putty-like consistency and may be dented, thedent remaining, and (c) it may sometimes be pushed along to a chfferent position EXAMINATION OF THE CERVIX UTERI 49 in the bowel. In a doubtful case, the bowels should be moved thoroughly bya purgative and the rectum cleared with an enema and the patient againexamined. In a patient with a lax pelvic floor, the anal tissues may be everted by pressurefrom within the vagina, by one or two fingers, as indicated in Fig. 61. When thetissues are very lax, the anus may be opened widely and the rectal mucosa ex-posed (Fig. 62). This turning out and examination of the anal tissues is advisablewhenever there is pain on defecation or bleeding or other evidence of trouble in thisregion. In this way the presence or absence of hemorrhoids or fistula or fissuremay be Fig. 61. Method of everting the anal tissues forinspection. CERVIX UTERI. POSITION, SIZE, SHAPE, CONSISTENCY, TENDERNESS, MOBILITY, ATTACHMENTS, DIRECTION IN WHICH IT POINTS, LACERATION WITH EVERSION OF LIPS, SIZE AND SHAPE OF EXTERNAL OS. The cervix uteri is felt at the upper end of the vagina as a firm, conical body, pro-jecting through the upper portion of the anterior wall (Figs. 1 and 3). It is distin-guished from the surrounding vaginal wall by its greater hardness. Position of Cervix. The normal position of the cervix is from three to three andone-half inches from the vaginal orifice. The fingers are carried toward the top of 50 THE PHYSICAL EXAMINATION the vagina until the tip of the finger touclies the cervix. If the vaginal orifice comeswell up to the upper end of the third joint of the finger, the cervix is in normal posi-tion (I assume a hand of average size, with index finger about three and three-fourths inches long.) I
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