142 DISEASES OF THE UTERUS. 



ANATOMICAL APPEARANCES. On autopsy, flexions of the uterus 

 may be readily recognized, as part of the anterior or posterior wall 

 of the body, instead of the fundus, forms the highest part of the 

 uterus. Generally we may readily restore the sunken fundus to its 

 position, but it sinks back again to its former place when we let go 

 of it. In some cases it cannot be restored to its normal position on 

 account of peritoneal adhesions with the surrounding parts. Be- 

 sides the flexion, there is almost always a slight anteversion or re- 

 tro version. If we cut the uterus out of the body, and hold it erect 

 by the vaginal portion, the fundus sinks down, either anteriorly or 

 posteriorly ; if it be held horizontally, it not unfrequently holds its 

 weight if the flexed portion be upward, but it bends together if we 

 reverse it. The point of flexion is always near the internal os uteri. 

 Here the flexion is sometimes slight, sometimes at right angles, or 

 even at an acute angle. The os uteri is almost always moderately 

 open, even in women who have had no children ; this is a natural 

 result of the tension on the anterior lip in retroflexion, on the pos- 

 terior lip in anteflexion. The internal orifice, on the contrary, is 

 contracted partly by the flexion itself, partly by the swelling of the 

 mucous membrane. In older women, we occasionally find complete 

 atresia of the internal os uteri. The contraction or closure of the 

 internal os uteri causes more or less hydrometra. The disturbance 

 of circulation at the point of flexion sufficiently explains the almost 

 constant complication with catarrh of the uterus, ulcers of the os, 

 and parenchymatous metritis. 



SYMPTOMS AND COURSE. The most constant symptoms of flexion 

 depend on the impeded escape of the contents of the uterus. Hence 

 the patients usually suffer severely from dysmenorrhoea as long as 

 they continue to menstruate. Small clots of blood that has coagu- 

 lated in the uterus are often mixed with the menstrual blood, which 

 is evacuated with severe uterine colic. Uterine colic may also be 

 caused, in the interval between the menses, by the impeded escape 

 of the mucous and serous secretions, retained above the point of 

 flexion. In many cases there are also the symptoms of uterine 

 catarrh, as described in the first chapter, the fluor albus uterinus, 

 decided loss of blood during menstruation, etc. Difficult and pain- 

 ful evacuation of the rectum, desire to urinate and pain while doing 

 so, the signs of anaemia and bad nutritive condition, and finally the 

 disturbances of innervation that have been so often mentioned, com- 

 plete the description given by many women suffering from flexion 

 of the uterus. But we must add that sometimes women with very 

 decided flexions of the uterus never have any, or have but few, of 

 these symptoms ; or, if they do occur, they soon pass off without 



