Cervix

“ If the prolapse of the lower vagina progresses faster than that of the uterus, then the vagina will begin to drag upon the cervix, to which it is attached, and under these circumstances the uterus will be subjected to two downward forces—intra-abdominal pressure from above, and traction of the vaginal walls acting from below. ”

“ In adults the circumference of the body of the uterus is greater than that of the cervix; before the age of puberty it is less than that of the neck. In old age the entire organ contracts, but the body more than the cervix, so that the organ again assumes an infantile form. ”

“ The external os in the virgin uterus is round or oval; in women who have borne children it appears as a transverse cleft. The most common conditions of the cervix are the so-called erosion and ectropion, cystic glands (ovula Nabothi) , cervical catarrh, hyperplasia, ulcers, polypi, myofibroma and carcinoma. Note contents of cervical canal (normally glassy, tough mucus; in catarrh becomes thin, cloudy or purulent) ; length and shape of canal (elongations, dilatations, stenosis, etc.) . Color of mucosa should be grayish-red; the folds should be distinct and symmetrical. ”

“ When the cervix is fully dilated, the membranes, or bag of waters, usually rupture, and there is a sudden gush of fluid, but the rupture of the membranes does not necessarily mark the end of the first stage. Sometimes, though not often, they break before labor begins, thus producing what is known as a “dry” labor. They may rupture before the cervix is fully dilated or they may not rupture at all until the doctor punctures them to facilitate the baby’s birth. ”

“ In cases of prolapse in which the cervix has reached or has passed the ostium vaginæ, rest in bed in the recumbent position should always be prescribed for two to four weeks before any operative procedure. The woman should be placed in the knee-chest position and the prolapse of the uterus and vagina should be reduced. ”

“ The abdomen is opened in the usual way and the uterus is withdrawn from the abdomen and the arteries controlled by forceps, and the broad ligaments divided exactly as in the case of the subtotal operation. Unless the uterus be very big it is drawn well out of the abdomen and the bladder peeled off its anterior aspect. The surgeon then feels for the extremity of the cervix and opens the vagina with the scalpel and carefully detaches it from the neck of the uterus, taking great care to keep close to the cervix in order to avoid wounding the bladder or the ureters. ”

“ With a catheter previously introduced it is much more readily explored.
‘The septum between the vagina and the rectum is so thin that, should the rectum contain fæcal matter, its presence becomes at once apparent to the finger.
‘The cervix uteri is felt protruding from the roof of the vagina in a direction downwards and backwards—that is, in a line from the umbilicus to the coccyx. The os uteri is felt, small and round, in the centre of the cervix. The posterior lip feels a little lower than the anterior. ”

“ Sometimes the cervix becomes hypertrophied by general infiltration to three or four times its usual size.
The broad ligaments are very usually involved by direct extension of the disease. They become thick, hard, and very rigid, holding the uterus fixed in the pelvis. When only one ligament is affected, the uterus is drawn to that side. The ureters become involved by extension of the infiltration to their walls or by pressure upon them by the thickened broad ligaments. ”

“ The abortionist first introduces the most slender of these instruments into the cervix, to dilate the cervix, turns the instrument around to a slightly larger end, introduces that end, and then works his way through the various, graduated, increasingly larger ends of this dilating instrument. ”

“ This procedure, which is used only rarely, is performed on mid- to late-second-trimester (and sometimes third-trimester) fetuses. [6] Although there are variations, it is generally performed as follows: After dilating the cervix, the physician will grab the fetus by its feet and pull the fetal body out of the uterus into the vaginal cavity. 11 F. Supp. 2d, at 1106. At this stage of development, the head is the largest part of the body. Assuming the physician has performed the dilation procedure correctly, the head will be held inside the uterus by the woman's cervix. ”

“ In many cases, the contracted and narrowed condition of the canal of the cervix seems to be a congenital deformity, for we can trace it to no perceptible cause. It is also true that contraction and partial, or even complete, stricture of the cervix, or neck of the womb, often results from the improper application of strong caustics to this passage by incompetent and ignorant surgeons. Every person has observed the contraction of tissue caused by a severe burn, which often produces such a distortion of the injured part as to disfigure the body for life. ”

“ Treatment.—All forms of laceration of the cervix in which there exist eversion, erosion, cystic degeneration, and sclerosis should be operated upon. A slight laceration in a young woman in the active childbearing period does not demand operative treatment if there are no symptoms referable to the laceration. ”

“ Sometimes the physiological angle of flexure becomes obliterated in consequence of chronic metritis, resulting in permanent straightening of the uterus, and the cervix becomes elevated and fixed above, or the corpus depressed and fixed below, the normal level. ”

“ The skin darkens in the axilla and in the areola of the breasts. A dark line presents itself down the middle of the abdomen. The vagina takes on a violet tint, the cervix becomes purple, the various colors becoming more marked with the progress of pregnancy. ”

“ Attention must be drawn to the fact that the vagina, cervix, uterus and tubes form a continuous canal from the vulva to the easily infected peritoneum, a fact which makes absolute surgical cleanliness in obstetrics virtually a matter of life or death to the patient. ”

“ The ulcerations of the cervix so often found in young girls and young mothers of one child may often be attributed to no other cause than to frustrate eroticism in the young girls and to onanismAT in the young mothers. The cervix is damaged in the same way as the soil, burned by the sun, in the absence of a beneficent rain, cracks and slits. ”

“ At the end of seven months, Aur. mur. nat. had entirely reduced the swelling. The woman has enjoyed good health for several years, quite free from the so-called hysteria.
Induration of Cervix.
It happened that a woman presented an induration of the cervix, together with a remarkable softening in the posterior uterine wall. The result of treatment with chloride of gold was, that in proportion to the decrease of the induration there was an increase in the consistency of the softened posterior wall. ”

“ The uterus of a woman who has attained complete sexual maturity, has undergone such alterations in its proportions that the cervix and the body are of almost the same length. The constriction, visible externally, indicating the separation between these two segments of the organ, is depressed somewhat toward the external os. In sexually active women, a widening and an increased curvature of the region of the fundus occur, the uterine extremities of the Fallopian tubes becoming more widely separated ”

“ The second was a duplicate of the first, excepting that a few bands extended from the cervix to the membranous septum. In the third the lumen of the vagina, about two inches from the introitus, was distinctly narrowed by a ridge of tissue. There was uterine displacement and some endocervicitis, but no history of injury or operation and no tendency to contraction. The two remaining cases occurred in patients seen by Dr. J. F. Scott. In one the septum was about 1 3/4 inches from the entrance to the vagina and contained an orifice large enough to admit a uterine probe. ”

“ In women who have given birth to one or two children, and then for a long time have remained barren, we not infrequently find deep cervical lacerations. Breisky, Spiegelberg, Schultze, and Goodell have operated in such cases, and shortly after the operation pregnancy has recurred.
Displacements of the Uterus. With less justice than in the case of the pathological changes in the cervix above described, it is maintained that displacements of the uterus form a very frequent cause of mechanical hindrances to conception, and thus give rise to sterility. ”