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LONDON-F. J. RBBMAN, MANAGER, 40 BERNERS STREET, OXFORD STREET, W.
PARIS-H. LE SOUDIRR, 117 BOULEVARD ST. GERMAIN.
VIENNA-Josep Safar, VIII SCHLOSSELGASSE, 24.
TOKIO, JAPAN–Z. P. MARNYA & Co.

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CLINICAL LECTURE

its most marked constriction at the external opening, where we have the vulva, with its

longest diameter at right angles to that of the PROLAPSUS OF THE VAGINA— vagina. The orifice of the vagina and its posOPERATION.

terior segment are re-inforced by the muscles By E. E. MONTGOMERY, M.D.,

which form the perineum; these in their norProfessor of Gynæcology in Medico-Chirurgical College : Ob- mal muscular tonicity aid in the support of the

stetrician to Philadelphia Hospital ; ex-President American Association Obstetricians and Gynæcologists.

vagina and the viscera above. Its position is ENTLEMEN: A few weeks ago I still further maintained by its relation to the

brought before you a woman suffering levator ani muscles, which pass on either side from a protrusion of the vaginal walls. This of the vagina, and to which its walls are parprotrusion affected more particularly the an- tially attached. The vagina is a musculo-memterior surface, which presented a globular, branous canal, having three walls, from without rounded mass, and was greatly increased in inward,—the areolar fascia, the muscular wall, coughing or straining. This protrusion is and the mucous membrane. The latter is lined known as a cystocele. Before entering upon with pavement epithelium, and does not differ its further discussion, however, it is well that greatly from the skin when subjected to similar we say something of the anatomy of the vagina conditions. The vagina is 272 inches in length and the forces that retain it in its normal on the anterior wall and some 4 inches on the position.

posterior. This difference in length is due to You will see the vagina, in the ordinary ana- the manner in which the cervix projects into tomical text-books, represented as a widely dis- the vagina, which is at the expense of the tended canal, closed by the uterus above, as a anterior wall. cork in a bottle. This is not a correct repre

Anteriorly, the vagina is closely connected sentation, and gives false ideas as to the arrange with the bladder, and the urethra forms a cordment. The vagina is the passage which leads like projection into its wall. The association from the vulva to the uterus, and is a closed with the bladder is so intimate as to render it canal, standing at an angle of sixty degrees exceedingly difficult to completely separate with the horizon when the patient is in the these viscera. Posteriorly, the peritoneum exerect position. In making the transverse section, tends over the whole of the posterior surface you will see that the vagina is simply a slit in of the uterus down upon the surface of the the pelvic floor, and that any protrusion of its vagina to the extent of from 12 to 1 inch, so walls, or of the uterus through it, is as much a that, introducing the finger into the vagina behernia as would be the protrusion of the viscera hind the uterus, but 13 inch of tissue intervenes through the other natural canals of the abdomen. between the finger and the peritoneal cavity.

The widest portion of the vagina is that into | The mucous membrane of the vagina is thrown which the uterus projects, and it narrows down into folds or rugæ, and consequently presents a as we approach the vulvar orifice, presenting roughened sensation to the finger. Under

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