UTERUS (ABNORMAL ANATOMY). 



683 



retained by them after the pelvis has changed 

 its form, may give rise to the malformation 

 under consideration.* 



b. Retroftexion exhibits the converse pecu- 

 liarity, the body of the uterus being bent back- 

 wards upon the neck at such an angle that 

 the fundus occupies a position more or less 

 deep between the cervix and rectum, filling 

 and distending the pouch of Douglas. This 

 condition of the uterus ought not to be con- 

 founded with retroversion or with those retro- 

 uterine tumours produced by inflammation, 

 and effusion into the cellular tissue (Jig* 433., 

 G) at the back of the cervix, of which an 

 account will be presently given. See p. 688. 



c. Lateral inflexion. The uterine body ex- 

 hibits occasionally an inclination to lateral 

 curvature, so that the fundus is directed to- 

 wards one or other side. A curvature out- 

 wards, in the form of an arch more or less 

 deflected from the meridian, has been shown 

 to be the usual condition of the uterus uni- 

 cornus. But where a tendency towards 

 either side is shown in the otherwise normally 

 formed organ, this appears to arise from some 

 inequality in the development of the two 

 uterine halves; or it may depend upon one 

 half undergoing hypertrophy, so that in either 

 case one uterine angle lies higher than the 

 other, and a vertical line would divide the 

 organ into two unequal parts. The cervix is 

 here curved as well as the body, or the latter 

 may remain perpendicular while the body is 

 bent so as to form an angle with the cervix. 

 The former variety has been designated the 

 retort-shaped uterus. 



Anomalies of Position. 



Obliquity of position, Hysterolojcia, Metro- 

 loxica, Obliquitas uteri. The foregoing defects 

 should not be confounded with those devia- 

 tions in position, without alteration of form, 

 which constitute the various obliquities of the 

 uterus ; like the inflexions of the uterus they 

 are distinguished according as the organ is 

 directed forwards or backwards in the median 

 line, or laterally in the transverse diameter of 

 the pelvis. 



a. Anti- and retro-versions. Situs uteri obliquus 

 anterior et jjosterior. Anti-version of the 

 uterus is by no means so common as retro- 

 version. Both affections differ from the cor- 

 responding anti- and retro-flexions of the organ 

 in this respect, that while in the two latter 

 cases the point of flexion is usually at the seat 

 of junction of the body with the cervix uteri, 

 in the former the uterus remains straight or 

 nearly so, while the entire organ is directed 

 forwards or backwards, and the seat of flexion 

 is at the junction of the cervix with the va- 

 gina. The displacement of the uterus is here 

 far more considerable than in the former 

 cases. 



In anti-version the degree of uterine dis- 



* See a paper in the Trans. Alicr. Soc. vol. v. 

 pi. 7. ; Quarterly Journ. Microscop, Scien., July, 

 1857, in which I have figured a human embryo of 

 four weeks, exhibiting this peculiarity in a marked 

 degree. 



placement is limited by the bladder and an- 

 terior wall of the pelvis, which generally 

 prevent the fundus from sinking so far for- 

 wards, as to give the entire uterus in the 

 unimpregnated state more than a horizontal 

 direction. An extreme degree of anti-version 

 however sometimes occurs at an advanced 

 period of pregnancy in multiparae, on account 

 of an unusual laxity of the abdominal walls 

 permitting the whole uterus to fall forwards, 

 so as to occupy the artificial pouch formed by 

 the pendulous abdomen, the fundus filling the 

 bottom of the pouch, while the cervix and os 

 uteri are tilted upwards and backwards, the 

 latter being lifted out of the pelvis, and point- 

 ing above the promontory of the sacrum. 

 This malposition materially impedes labour by 

 reversing the natural direction of the uterine 

 axis, so that the propelling force is expended 

 upon those parts that lie opposite to the os, 

 and the foetal head is prevented from entering 

 the pelvic brim. 



Retro-version occurs in conditions of the 

 uterus otherwise normal, or it may happen 

 when the organ is enlarged by disease or preg- 

 nancy. When unimpregnated the displaced 

 organ lies entirely, and when pregnant chiefly, 

 within the pelvic cavity. In retro-version, on 

 account of the excavation of the sacrum, the 

 fundus readily descends so low as to admit of 

 the normal relations of position of the os and 

 fundus being nearly reversed. The latter being 

 directed downwards and backwards towards 

 the coccyx, while the former is tilted upwards 



Fig. 468. 



Retro -version of the uterus. (Diagram.") 



and forwards, so as to lie behind, or in ex- 

 treme cases above, the symphysis pubis. In 

 extreme retro-version a line drawn through the 

 uterine cavity would represent nearly the 

 normal axis of this organ, but instead of pass- 

 ing out backwards through the posterior cer- 

 vical wall, it will pass out forward through the 

 anterior wall, because the stretching of the 

 vagina in these cases will cause a slight degree 

 of flexion of the cervix downwards. The 

 sequelae of this displacement in the case of 

 the gravid uterus, when artificial or spon- 



