File:Gynecological diagnosis (1910) (14775868774).jpg

Identifier: gynecologicaldia00burr (find matches)
Title: Gynecological diagnosis
Year: 1910 (1910s)
Authors: Burrage, Walter L. (Walter Lincoln), 1860-1935
Subjects: Women
Publisher: New York, London, D. Appleton and Company
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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the upper vagina shows the cervix tobe of a purplish color, soft to the feel, and in primiparse the ostincsc becomes rounder. Erosions arc of a deeper purple color thanthe surrounding tissues. Many observers consider the discolorationof the cervix an earlier and more constant sign than Jacqueminssign. As congestion of vagina and cervix may be found in pelvicdisease, such as large ovarian and uterine tumors obstructing thevenous circulation, and in certain constitutional diseases, as heart FIRST THREE MONTHS OF PREGNANCY 423 disease and cirrhosis, the physician must be on his guard. Thetypical discoloration of pregnancy is, however, limited to the loweranterior vaginal wall, about the lower urethra, and to the cervix;whereas in pelvic disease and constitutional disorders the con-gestion is general. The Bimanual Touch.—This is practised wTith the patient in thecustomary dorsal position (see page 33). The finger notes a softcervix. It is to be remembered that softening of the cervix is
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Fig. 177a.—The same, during Contraction. found also in septic conditions of the uterus, as in septic endome-tritis, so that a soft cervix is not pathognomonic of pregnancy.The uterus itself is a little lower in the pelvis than normal, and isenlarged by the growing ovum, which is usually attached to theendometrium in the neighborhood of the orifices of the tubes. Theuterus grows faster than the ovum at first, and the ovum withits envelopes does not fill the uterine cavity until the end of thethird month, when the decidua reflexa joins the decidua vera. The first change in shape noted in the gravid uterus consists ina slight enlargement of its transverse diameter; then it becomeslengthened and fatter as the ovum increases in size, especially in 424 NORMAL UTERINE PREGNANCY the anterior part of the body of the uterus; this anterior bulgingbeing quite characteristic in many cases. Asymmetry is causedby the development of the ovum in one cornu, a not uncommonhappening. Uterine enlargemen

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