14-Q DISEASES OF THE UTERUS. 



thinned, there is occasionally distinct fluctuation ; if they be hyper- 

 trophied, we do not find this most important sign for distinguishing 

 hydrometra from almost all other uterine tumors. Occasionally 

 there is uterine colic, particularly during severe congestions of the 

 uterus. If the closure be incomplete, these contractions sometimes 

 force out the collected fluid, and, according to tScanzoni, occasion- 

 ally also gases that have formed from them. The treatment of hy- 

 drometra consists in surgically making a passage for the liquid, and 

 in attempting, by astringent injections, to limit the secretion of the 

 mucous membrane. 



CHAPTER V. 



CURVATURES OF THE UTERUS FLEXIONS AND INFARCTIONS. 



ETIOLOGY. [Any abnormal change between the directions in the 

 axis of the neck of the womb and that of its body is called a flexion ; 

 but it must be borne in mind that when the bladder is empty the 

 womb is normally bent slightly forward. The bend or angle is 

 nearly always at the internal os. When the deformity is such that 

 the fundus inclines forward, and the curve or angle included be- 

 tween it and the cervix is anterior, we have an anteflexion ; the con- 

 trary constitutes a retroflexion. There may also be lateral flexions, 

 but they are rare.] 



There are various views regarding the pathogeny of these dis- 

 tortions. Most authors think that the causes of the flexure lie in 

 the uterus itself, and support their view on the fact that, at the 

 point of distortion, the wall of the uterus is always flattened, and 

 its parenchyma loose and reflexed. Virchoio considers the changes 

 at the point of flexion as secondary symptoms, due to the pressure 

 on the walls of the uterus at this point, and to the anaemia of the 

 parenchyma caused by this pressure. It is his opinion that most 

 distortions of the uterus, particularly anteflexions, are caused by 

 congenital or developed shortening of the ligament of the uterus, and 

 by its consequent fixation on distention of the bladder and rectum. 

 It is most probable that the causes of the flexions are not always the 

 same that they are sometimes within, sometimes outside of the 

 uterus. [Schultze believes that a posterior parametritis of insidious 

 course and somewhat frequent occurrence causes a shortening and 

 rigidity of the fold of Douglas, thereby producing a displacement 

 backward and upward and fixing of the cervix, which is the com- 

 monest cause of anteflexion as well as of anteversion.] 



Retroflexions, the most frequent form in women who have had 



