be met with, as sessile tumors, which at first obstruct the
passage of the sound. Sometimes, also, two distinct direc-
tions will be found in which the sound passes, as in a bipar-
tite uterus. Meanwhile the patient will herself have given
some indications ; at certain points she may complain of
pain, as in passing through the internal os, or when touch-
ing the fundus. If the bimanual examination has revealed
a tumor it will now be noted whether the sound passes
into it or not, and in the latter case whether movements of
the sound are at once conveyed to the tumor or vici' I'l-rsa;
in this way a uterine can often be distinguished from a non-
uterine tumor. When the tumor is uterine, by placing one
finger in the anterior and the other in the posterior fornix.
or with one finger in each lateral fornix, it may be possible
to determine whether the tumor is in the anterior, posterior,
or side wall of the uterus.
As the sound is withdrawn, it may be felt to be gripped,
cither by spasm or by mere narrowness of the passage ; we
have here the test of stenosis. If, while the sound is intro-
duced as far as possible, the finger be placed on it up against
the cervix, and it be kept in this position when the sound is
withdrawn, the length of the cavity can be exactly read off
Lastly, we look at the sound, to see if its introduction has
caused bleeding.
