CURVATURES OF THE UTERUS. 141 



children, are, on the other hand, rare in those who have had none ; 

 they almost always date from the time of a confinement or an abor- 

 tion. If the involution of the uterus go on slowly after its contents 

 have been evacuated, if it remain enlarged and relaxed, the fundus 

 readily sinks down on account of its weight, or is pressed down by 

 the other contents of the abdomen. As the greater part of the ute- 

 rus remains in the posterior wall after delivery, it is natural that it 

 should most frequently sink backward ; but we cannot wonder if 

 there are deviations from this, as they may readily be induced by 

 different positions of the distended intestines in the vicinity, and by 

 other accidental causes. At this period a complete return to the 

 normal state is certainly possible. The bending of the uterus is 

 straightened out when it contracts early. But, if this do not take 

 place soon, the parenchyma, at the point of curvature, becomes 

 anaemic and atrophied from the continued pressure, or the fundus 

 uteri forms some abnormal attachment. In either case we have a 

 permanent .anomaly a distortion in the strict sense. Scanzoni men- 

 tions, as the most frequent cause, the slow and incomplete involu- 

 tion of the uterus, and, as the most important etiological factors of 

 the retroversion, early marriages, frequent and quickly repeated 

 pregnancies, abortion, artificial delivery, etc. 



Anteflexions chiefly occur in those who have had no children. 

 In young persons the most frequent cause seems to be a relaxation 

 of the substance of the uterus by chronic catarrh ; in aged persons 

 it is a senile atrophy of the uterus, at the point where these distor- 

 tions always occur, that is, near the internal os uteri. It is easy to 

 understand that anteflexion should be the more frequent form of 

 distortion in women who have had no children, if we remember that 

 a virgin uterus has normally a slight inclination forward. In this 

 case also, it seems to me, there is no doubt that the flattening of the 

 wall of the uterus, and the atrophy of the tissue at the point of 

 flexion which takes place after a time, are due to the pressure and 

 anosmia. 



Besides these flexions, caused by anomalies of the substance of 

 the uterus, there are others which are undoubtedly caused by short- 

 ening of the uterine ligaments, as is proved by the cases observed 

 by Virchow, where there were flexions without any structural change 

 in the parenchyma. ' In the same way, distortion may result from 

 fibroid tumors in the anterior or posterior wall of the uterus, from 

 tense adhesions, or from the pressure of tumors. The more securely 

 the lower portion of the uterus is held in place by a rigid vagina, 

 the more readily flexions occur ; the less firmly it is held, the more 

 often displacements will occur instead. 



