The first subjective symptoms of injury to the supports of the pelvic floor that appear when the woman leaves her bed are those referable to beginning prolapse of the uterus. Backache is the most common symptom, and occurs here as in almost every other disease of the uterus. The pain, a dull ache, is situated in the upper part of the sacrum. It is increased by standing, by walking, or by manual labor. It often disappears entirely when the woman lies down and the intra-abdominal pressure is removed from the uterus. Headache situated in the occipital region or the vertex is also usually present, and varies in severity with the severity of the backache. Pain extending down the posterior aspect of the thighs, and a dragging feeling of loss of support in the pelvis, may also be present. The rectal and bladder symptoms occur later, when rectocele and cystocele appear. There is often very marked general physical weakness, much of which may be referred directly to the loss of the muscular support of the perineum. Almost every effort that the woman makes is accompanied by increase of intra-abdominal pressure, and she feels keenly the loss of the accustomed perineal support which normally resists any increased abdominal pressure. In the sound woman the perineal muscles contract and the vagina is more tightly closed to meet the increased pressure incident to a muscular effort. In the injured woman the vagina is open and the pressure is resisted by weak vaginal walls and uterine supports. She feels that her point of resistance is gone. The best proof of the profound effect of injury to the perineum upon the general strength of a woman is given by the operation of perineorrhaphy. The repair of this apparently slight lesion restores the woman to her former strength. The =diagnosis= of prolapse of the uterus is readily made by examination. In the extreme cases the cervix and the greater part of the body of the uterus are found outside the vulva. In less marked cases the cervix is seen presenting at the vaginal orifice as soon as the labia are separated. In other cases the cervix is felt by the vaginal finger resting on the pelvic floor. It should be remembered that every case of prolapse is greater when the woman is standing than when she is being examined upon her back. Sometimes the cervix will present at the vulva, where it may be felt when the woman is erect; but when she lies down and intra-abdominal pressure is removed, it retreats beyond inspection except through the speculum. In order to determine the full extent of prolapse, therefore, when the woman is examined on her back she should be directed to strain or bear down, when much more marked descent of the uterus and vaginal walls will become apparent.