Identifier: diseasesofwomenc00herm (find matches)
Title: Diseases of women. A clinical guide to their diagnosis and treatment
Year: 1899 (1890s)
Authors: Herman, G. Ernest (George Ernest), 1849-1914
Subjects: Women
Publisher: New York, W. Wood & Co.
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

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ion. The diagnosis of retroflexion.—On vaginal examinationa lump is felt behind the uterus. This lump is the bodyof the uterus. The problem in diagnosis is to identify it assuch, and to exclude every other condition. (1) The lump isof the size, and has the symmetrically rounded shape of theuterine body. (2) On bimanual examination you cannot feelthe body of the uterus in its natural position above the cervix.If the lump is a tumour or a pelvic effusion pushing theuterus forwards, you will feel the body of the uterus withthe external hand more easily than usual, because it is * See papers by the author, Obst. Trans., vols, xxxiii., xxxiv., and xxxv.f For evidence of these statements see papers by the author in Obst.Trans., vols, xxxiv. and xxxv. 148 DISEASES OF JTOMEX. pushed nearer the abdominal wall. (3) If bimanualexamination is not decisive, as may be the case in a fator nervous patient, ascertain from the history that thereis no reason to suspect pregnancy, and if there be none,
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Fig. 56.—The diagnosis of retroflexion by the sound, which enters with the concavitybackwards (a). When rotated, so that it comes into the position shown bydotted outline (b), the retro-cervical swelling is removed, and the body of theuterus can be felt by the hand on the abdomen. (After R. Barnes.) pass the sound. If the lump is the body of the retro-Hexed uterus, the sound will pass upwards and forwards forlittle more than an inch ; but turn the concavity backwards,and it enters the full length of the uterine canal (Fig. 56). Ifthe flexion be sharp you may have to bend the sound a little UTERINE DISPLACEMENTS: RETROFLEXION. 149 more before it will enter. There is one possible fallacy in thediagnosis made from the direction in which the sound enters.The uterus may be retroflexed, but the lump you feel may notbe the uterine body, but a swelling of another kind below theuterine body (Fig. 57). In order to be certain that the lumpis the uterine body, move the handle of the sound (not

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