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looned out.

The child nursed well spontaneous movements the lower limbs were normal, though the reflex motions were slow. Unfortunately Professor Epstein's efforts obtain permission for a post-mortem examination in the probable event the child's dying were Under these circumstances can say but little as the anatomical conditions present which had led the prolapse all the organs that lie along the floor the pelvis.

I can only surmise that an imperfect development, and perhaps an abnormal position the muscular structures the pelvic floor, may have caused its relaxation, and the dilatation of the places exit urethra, vagina, and rectum. The presence fissure the symphysis and spina bifida would favor this view. There are no other anatomical investigations concerning paper writing services reviews the condition the muscular and aponeurotic pelvic floor in these cases. Not only is this with rare congenital anomalies such as have been edit essays considering, hut also the case with the very frequent acquired descensus and prolapsus. From a clinical point view Schatz and Emmet have called attention the importance the ruptures and best thesis writing service contusions the muscular structures the pelvic floor incidental childbirth and i need help to write a essay Hegar has insisted upon its efficacy as the etiological agent in displacements of Billroth has recorded a case prolapsus uteri with vesical ectopia in a girl eighteen years old, and has added a handsome drawing The sketch shows that the pelvis was fissured and the perineum imperfectly Among the more recent literature a case Prochownik's deserves mention here. The girl was a virgin, twenty years old, and had prolapsus septus with congenital deficiency the perineum. Prochownik believes that the earlier occurrence the prolapse in this case was prevented by the tension the lateral attachments the uterus, although a deficient development the muscular structures the pelvic floor could recognized. I think also that the shape and breadth the womb, in relation the lumen the vagina, had something with After the patient had had very hard work upon very poor food for seven months, a prolapse occurred.

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It was well retained a Schatz pessary. Undoubtedly dilatation and relaxation the introit. vaginae can usually proven among the efficient causes vaginal dislocation.

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Yet the infl nence rupture the perineum as a predisposing moment, has been much overestimated, since without doubt the larger number vaginal prolapses occur without its being present. The loosening the attachments which have described explains the occurrence a displacement in layers the septum vesicas and rectovaginal in those cases in which the bladder or the rectum does not follow the dislocation.

Only in exceptional instances are unable to prove the anatomical reasons for predisposition the vaginal attachments loosened and in these the thesis writing assistance amount pressure or traction must have been enough overcome the resistance the normal means of As the participation neighboring organs, uterus, bladder, and rectum, in vaginal displacements, letter writing services must professional dissertation writing services distinguish between primary and secondary projections.

In the first case the vaginal walls sink account their loosened attachments, not being able withstand the normal amount pressure which bears upon them and the organs attached to the vagina follow In the second case the vagina permanently displaced the constant pressure and tension exercised upon the neighboring organs.

In advanced cases these causal relations cannot The protrusion the anterior wall descensus or prolapsus vagin. anterior may partial, and originates now from the lower and now from the paraphrasing in counseling upper segment the vagina or may complete. In both the latter cases regularly accompanied sinking the collum uteri. Partial descent the lower segment the wall, sometimes prolapsing a moderate extent through the vulva, dependent upon the projection forwards the lower extremity the columna rugarum ant. the tuberculum vag. Luschka, and the carina vag. Kohlrausch, just below the urethral orifice.