Text Appearing Before Image: Secondary descent of the ucerus. The uterus is retroverted andlies on a plane lower than normal. The cervix does not extend tothe vulvar outlet. The anterior vaginal -wall is prolapsed and theposterior vaginal wall is partially inverted. DIAGNOSIS OF MALPOSITIONS OF THE UTERUS 221 rectum, and vagina. While the author is in accord with this view,it is thought best to consider the subject along with other displace-ments of the uterus, as is the custom with most text-books. Web-ster, in his text-book on Diseases of Women, holds that prolapsusof the uterus, vagina, urethra, and bladder is the result of failureon the part of the fascial and other tissues supporting these organs Fig. 72 Text Appearing After Image: Torsion of the uterus caused by twisting of the pedicle of an ovarian cyst. between the bony walls of the pelvis to resist intra-abdominalpressure and gravity. If the power of resistance is weakened, orthe intra-abdominal pressure and weight of the uterus are increased,or if both factors co-operate, prolapsus will occur. Webster takesexception to the view of Hart, who regards the perineum as a fixedsegment for the support of the uterus, and of Thomas, who holdsthat the perineum is a supporting wedge. By anatomical dissec- 222 SPECIAL DIAGNOSIS tions Webster has demonstrated that the pelvic fascia and not theperineum and levator ani muscle is the real support. The various fascial tissues which meet in the perineum and givesupport to the pelvic viscera are: 1. The anterior and posteriortriangular ligaments. 2. The visceral layer of the rectovaginalfascia. 3. The anal fascia. 4. The deep superficial fascia. Web- FiG. 73
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