Diagnosis and treatment of diseases of women / by Harry Sturgeon Crossen.

  • Harry Sturgeon Crossen
Date:
1912
Catalogue details

Licence: Public Domain Mark

Credit: Diagnosis and treatment of diseases of women / by Harry Sturgeon Crossen. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    portions may heal in such a way that the hymen appears practically intact. Still rarer cases have been recorded in which the hymen softened and dilated sufficiently to permit the child to pass and then underwent involution to about its former size. Such a hymen is likely to stretch also during coitus instead of tearing. The examination of such a patient would show an intacli hymen, or, as some, laying too much stress on the condition of the hymen, are wont to write, virgo intacta. The absurdity of such a designation based only on the condition of the hymen is well expressed by Taylor when he re- marks, ''Such 'virgines intactae' have frequently required the assistance of accoucheurs and have in due time been delivered of children. b. Evidences of laceration or great stretching of the perineum, vagina and pelvic floor. These evidences are a large vaginal opening, close approach of the opening to the anus (partial destruction of perineal body), scars about the opening or on the perineum, lax vaginal walls and lax pelvic floor. These have about the same significance as the destruction of the hymen above mentioned—that is, their presence is strong evidence of previous childbirth but their absence is not of much legal significance. c. Laceration of the cervix. The establishment of a distinct laceration of the cervix is very strong evidence of a previous parturition or operation involv- ing division of the cervical wall. There are conditions that simulate a slight laceration, but a deep laceration Avould hardly be simulated by anything short of some congenital deformity, and in such a case there would be likely to be other deformities. Also, there would be no scar tissue, such as is ordinarily found about a laceration of the cervix. d. Evidences of previous lactation. It may be possible to press some fluid from the breasts, or the breasts may show the enlarged veins and the white striae (lineae albicantes) of a previous distention. e. Evidences of a previous distention of the abdominal wall . There may be present the striae (lineae albicantes) indicative of previous stretching of the skin from distention from pregnancy or other causes. When other causes (obesity, tumor, ascites) can be eliminated by the history, such striae indi- cate previous pregnancy. Also, marked relaxation of the abdominal wall may be due to previous distention by pregnancy. 2. Evidences of previous abortion. The evidences are exceedingly uncer- tain in many cases after a short time. There may be some slight lacerations, with resulting scars, that may be corroborative evidence, especially partial laceration of cervix. Their presence may help some, but their a])sence is of no particular significance. 3. Laceration of hymen and some dilatation and laxity of vaginal opening and vaginal canal. These are the ordinary evidences of coitus and are nearly ahvays present, especially if repeated coitus has taken place. Usually the opening in a virgin hymen is so small that the introduction of one finger is effected with some difficulty and causes pain. Ordinarily, after repeated coitus has taken place, the vaginal opening admits two fingers easily for examination, and without pain, providing the perineal edge of the opening is carefully depressed.