Page:Clinical Lectures on the Diseases of Women.djvu/42

32 of the patient and of the light, and the aid of an assistant. Besides, some exposure of the patient's person is scarcely to be avoided. After it, the best speculum is the mirror-glass speculum, which I show you. These specula are made of various sizes, and. you use the largest that you can intro- duce without difficulty.

The speculum only shows you a part of the disease, the part that used to be called the ulcer. It is now known that the disease often, indeed generally, affects the whole cervical surface, and in some cases, as in the one now in Martha ward, the neck of the womb is so softened, its muscular coat so relaxed or paralysed, that you can, by a probe, or spatula, open up the external os, and look into the cavity of the cervix. This makes the disease appear very extensive. In most cases the opening up of the cervix is impracticable.

I will now read you some details of the case. M. D., æt. forty-six, married twenty-two years, four children—last seven years ago—was admitted on January 8th.

She says her catamenia commenced at sixteen years, with intervals of three weeks between each period, and continued fairly regular up to the birth of her last child, seven years ago, whence she dates her present illness. Her catamenia then became more profuse, and recurred with intervals of fourteen days. Thirty-two weeks ago the catamenia stopped for ten weeks, and a yellow discharge came on.

During the last three weeks she has had severe sacral pain. She has also pain in the hypograstric region, and shooting pains down the thighs. She has also had a flooding, which lasted twenty-four hours, and she continued losing slightly for fourteen days after.

Per hypogastrium, nothing unnatural is found. Per vaginam—Cervix uteri is in normal situation, considerably enlarged by expansion, so that two fingers can easily be