Minor surgical gynecology : a manual of uterine diagnosis and the lesser technicalities of gynecological practice : for the use of the advanced student and general practitioner . ed to the vis afronte of gravitation and suspended intra-abdominal GYNECOLOGICAL EXAMINATION. 25 pressure. The vagina becomes elongated by the traction of the antevert-ed uterus, and if air enters is expanded like a balloon and every partbecomes readily visible. For purposes of digital examination this position is obviously unfittedthrough the elongation of the vagina already mentioned. It is mainly use-ful as a means
Minor surgical gynecology : a manual of uterine diagnosis and the lesser technicalities of gynecological practice : for the use of the advanced student and general practitioner . ed to the vis afronte of gravitation and suspended intra-abdominal GYNECOLOGICAL EXAMINATION. 25 pressure. The vagina becomes elongated by the traction of the antevert-ed uterus, and if air enters is expanded like a balloon and every partbecomes readily visible. For purposes of digital examination this position is obviously unfittedthrough the elongation of the vagina already mentioned. It is mainly use-ful as a means of replacing a dislocated, chiefly, retrodisplaced uterus,especially if the fundus has become impacted in the sacral excavation andresists digital replacement on the side. The prolapsed uterus or ovaries,and small incarcerated fibroid or ovarian tumors with long pedicles, arealso most easily replaced in this position, either spontaneously or by man-ual pressure. To determine the length of the intravaginal portion of the cervix, thisposition is invaluable. A cervix which appears greatly elongated, evento the vulva, will be no longer than normal when examination (sounding,. Fig. 6.—Genu-pectoral position—posterior view. (Hegar and Kaltenbach.) indagation, and inspection) is made in the knee-chest position. A pecu-liar, microscopically as yet unfathomed, ductile condition of the uterusis the cause of this phenomenon. In the dorsal or erect position theuterus draws out like putty ; in the knee-chest position gravitationcauses it to shrink. It is important to make this experiment in supposedhypertrophic elongation of the cervix and in prolapsus uteri. Pessaries are also at times advantageously applied in this position, andapplications of fluids made to the distended vagina. For operations theposition is not generally available, as it is too uncomfortable to be longborne, and the administration of anesthetics is difficult, if not impossiblein it. Palpation is rarely attended wit
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