THE METHOD OF MAKING POST-MORTEM EXAMINATIONS. 35 



bladder is then drawn strongly backward and upward, and dissected 

 away from the symphysis and the pubic arch, and, the point of the knife 

 being carried forward and downward, the vagina is cut off in its lower 

 third, the rectum severed just above the anus, the remaining attachments 

 cut, and the pelvic organs are taken out together. If it be necessary to 

 remove the external generative organs, after freeing the lateral surfaces 

 of the internal organs and the bladder, the legs are widely separated and 

 the vulva and anus circumscribed by a deep incision. The tissues close 

 beneath the pubic arch are now dissected away from below, and the 

 vulva is thrust back beneath the symphysis ; it is now seized above the 

 bone, and together with the anus dissected away and removed with the 

 other organs. 



The bladder is first opened and examined. The vulva may now be 

 examined for hypertrophies, inflammatory lesions, ulcers, cicatrices, 

 cysts, and tumors. The vagina is opened along the anterior surface ; its 

 more common lesions are inflammations, fistula?, ulcers, tumors, and 

 rarely cysts. 



The Uterus. Before opening this organ its size and shape should be 

 determined. The adult virgin uterus is a pear-shaped body, flattened 

 autero-posteriorly ; the upper portion, or body, is directed upward and 

 forward, while the lower portion, the cervix, is directed downward and 

 backward. It is covered anteriorly by peritoneum to a point a little 

 below the level of the os internum ; posteriorly, to a point a little below 

 the level of its junction with the vagina. The peritoneal investment 

 separates from the organ at the sides to form the broad ligaments. The 

 uterus is held in position by the broad and round ligaments and by its 

 attachments to the bladder and rectum and vagina. The upper end, 

 the fundus, does not extend above the level of the brim of the pelvis. 

 Its average length is about 7.6 cm. ; its breadth about 5.1 cm. ; its 

 thickness about 2.5 cm. ; its average weight is about 31 to 46 grams. 

 During menstruation the uterus is slightly enlarged, the mucous mem- 

 branes of the body becomes thicker, softer, and its vessels are engorged 

 with blood ; while its inner surface is more or less thickly covered with 

 blood and cell detritus. A description of the complicated changes in the 

 uterus which pregnancy entails may be found in the works on obstetrics. 

 After pregnancy the uterus does not return to its original size, but re- 

 mains somewhat larger ; the os is wider and frequently fissured. 



We not infrequently find in the mucous membrane of the lower part 

 of the cervix small transparent, spheroidal structures, called ovula 

 Xabothi ; these are small retention cysts caused by the closure of the 

 orifices of the mucous glands. The more common lesions observed in 

 the uterus are malpositions, malformations, lacerations, ulcerations of 

 the cervix, acute and chronic inflammation of the mucous membrane or 

 muscularis, or both, thrombosis and inflammation of the veins, and 

 tumors. 



In the infant the uterus is small, the body flattened, the cervix dis- 

 proportionately large. During childhood the organ increases in size, 



