EXAMINATION PER V AGIN AM. 73 



formed by the vagina in front and behind the cervix should 

 be perfectly elastic to the touch, and not communicate the 

 sensation of a resisting body. Any resistance here bespeaks 

 an abnormal condition. 



' The bony landmarks within reach of a ringer, or perhaps 

 two, in a woman who has not borne a child, are the symphysis 

 pubis, the rami of the pubes and ischia. The coccyx and 

 part of the hollow of the sacrum may also be felt, but not 

 without exerting much pressure on the posterior wall of the 

 vagina, which gives considerable pain. If the promontory of 

 the sacrum can be felt, it is a sign that the conjugate diameter 

 of the pelvis is abnormal. 



' The finger in the rectum can detect almost everything 

 which has been mentioned in connection with the vagina. 

 The shape and direction of the cervix uteri are almost as 

 perceptible, and the posterior wall of the uterus can be exa- 

 mined. The peritoneal fold termed recto-vaginal (Douglas's 

 space) can also be well explored, and anything abnormal 

 detected in this direction a point of great importance in the 

 diagnosis of diseases and displacements of the uterus. 



' The ovary in its normal state and position cannot be 

 detected by the touch even with the hand firmly pressed on 

 the hypogastrium. If a movable body be felt through the 

 vaginal roof on one side of the cervix, if this body be 

 exquisitely tender and recede at once from the finger, it is 

 an ovary in a state of prolapse. 



' The fundus of a healthy unimpregnated uterus never 

 rises above the level of the brim of the pelvis, and cannot 

 therefore be felt by pressing the hand on the hypogastrium. 



' The direction of the uterus is subject to changes which 

 cannot be looked upon as abnormal. The fundus may be 

 thrown backwards by a distended bladder, or forwards by a 

 distended rectum. The axis of its cavity is not a straight 

 but a curved line ; and uterine sounds should be shaped to 

 suit it.' 



