[Illustration: FIG. 139.--Inversion of the uterus (Jeançons): _a_, mons veneris; _c_, _c_, nymphæ; _d_, clitoris; _e_, external meatus; _g_, anterior lip of cervix; _h_, _h_, the internal surface of the uterus.] The symptoms of chronic inversion are hemorrhage, discharge, backache, bearing-down pains in the pelvis, vesical disturbance, very pronounced anemia, and general physical weakness. Menstruation is very much increased in amount, and intermenstrual bleeding may occur after standing or on any physical effort. Inversion of the uterus very rarely exists without causing serious symptoms. The majority of unrelieved cases end fatally from anemia, septicemia, or peritonitis. A few cases of spontaneous reduction and cure have been recorded. The =diagnosis= of recent inversion is very easy. The body of the uterus usually projects into the vagina, and the placenta may be found attached to it. The abdominal hand fails to feel the rounded body of the uterus in the normal position, but in its place is a cup-shaped hollow. Chronic inversion if uncomplicated by other lesion--_e. g._ a uterine tumor--may also be readily recognized by careful examination. There are, however, a number of cases on record in which the inverted fundus uteri was amputated in mistake for a fibroid polyp. The diagnosis may be made by inspection, bimanual examination, and the uterine sound. In complete inversion, inspection shows a round tumor filling the vagina or protruding from the vulva. The tumor is covered with mucous membrane, perhaps ulcerated in places, and sometimes partly covered with stratified squamous epithelium, which has, as a result of irritation, replaced the normal epithelium of the endometrium. It is of a deeper red color than a pedunculated fibroid. The tumor bleeds easily. In the only case of inversion seen by the writer the orifices of the Fallopian tubes could be determined. Digital examination reveals the rounded shape of the tumor and its soft character--softer than a fibroid polyp. The tumor may be so soft that it becomes flattened against the posterior vaginal wall. The tumor is found to be free on all sides except at its upper extremity, where there is a pedunculated attachment around which may be felt the more or less attenuated cervix. If the cervical canal be not obliterated by adhesion to the neck of the tumor, the finger may be passed upward, and will determine that the mucous membrane is reflected symmetrically all around on to the neck of the tumor. Unless the woman be fat, the abdominal hand will determine that the uterine body is not in its normal position. In its place may be felt the cup-shaped portion of the inverted uterus. If the woman be fat, the rim of the cup may be felt by palpation through the rectum, the uterus being drawn down, if necessary, by a tape passed around the upper portion of the tumor.