CURVATURES OF THE UTERUS. 143 



the disappearance of the flexion. Sterility itself, although very fre- 

 quent, does not constantly accompany flexions of the uterus. Hence 

 it appears that it is not the flexions, but the other anomalies of the 

 uterus, which complicate them, that cause the symptoms above de- 

 scribed. These complications are so frequent that their absence is 

 an exception. This is partly because the same injurious influences 

 that induce the flexions also excite the different forms of metritis ; 

 partly because the disturbances of circulation at the point of flexion 

 cause hypersemia and exudation in the parenchyma, mucous mem- 

 brane, and serous covering of the uterus. The course of flexions is 

 very tedious. The disappearance of the condition is exceedingly 

 rare, if it ever takes place. Flexion can only disappear completely 

 if new parenchyma is formed in place of the flattened and atrophied 

 uterine tissue. When, with advancing years, the periodical recur- 

 rence of physiological congestion of the uterus ceases, all the symp- 

 toms usually moderate ; and when, in aged persons, the uterus and 

 part of its blood-vessels become atrophied, the patient may feel 

 pretty well. 



On physical examination, the finger introduced through the va- 

 gina first feels a dislocation, anteriorly or posteriorly, of the portio 

 vaginalis, caused by the coexistent anteversion or retroversion. We 

 also generally find the os so patulous that the point of the finger 

 may be readily passed into it, even in women who have had no chil- 

 dren. From the vagina, either before or behind the vaginal portion, 

 we may find the body and fundus of the uterus, forming a round, 

 firm, movable tumor. Usually, also, we may reach the point of 

 flexion. The fact that the opposite part of the vagina is empty 

 prevents our mistaking a flexed uterus for one that is enlarged, or 

 diseased in some other way. The introduction of the uterine sound 

 aids the diagnosis ; but when the uterus is flexed this operation is 

 peculiarly difficult, and we again repeat that, in the hands of an 

 unskilful physician, or even in those of a skilful one, the uterine 

 sound is a dangerous instrument, which should be used as little as 

 possible. 



TREATMENT. We have already said that total disappearance of 

 a flexion must to a certain extent be considered as a physiological 

 impossibility, as it is almost always accompanied by atrophy of the 

 parenchyma of the uterus at the point of flexion. " Flexion instru- 

 ments," sounds, redressers, and intra-uterine pessaries, which were 

 for a time much used for flexions, do actually no good, but much 

 harm. Scanzoni has stated plainly that in his large gynecological 

 practice he has never cured a flexion, and that he considers the use 

 of flexion instruments as of no use, and dangerous. Tonics also, 



