396 



Tlte Uterus 



The spinal column bent this way or that does not necessarily want a 

 support, nor does the womb. 



In ante version the finger in the vagina fails to find the cervix 

 at first, but eventually makes it out high up, and directed so much 

 backwards that the os lies against the posterior vaginal wall. Through 

 the anterior wall the finger detects the body of the uterus running 

 forwards as a firm ridge towards the pubes, the fundus pressing 

 against and irritating the bladder. The patient lying on her back, 

 the uterus may be pushed up by the finger through the front of the 

 vagina, and by the other hand working over the pubes. To keep it 

 then in position, the patient must lie constantly supine ; the bladder 

 may be kept full and a binder applied. If necessary, a uterine support 

 (a pessary) may be worn. It should not be left too long in position, or 

 it may cause ulceration. A pessary has been known quietly to work 

 its passage into the rectum, bladder, or uterus. 



In anteflexion the fundus is bent forwards, with the result, if the 

 flexion be extreme, of irritating the bladder ; otherwise the symptoms 

 may be only those due to the impeded escape of the uterine fluids 

 dysmenorrhcea. The displacement is apt to follow extensive rupture of 

 the perineum, for the bladder, having thus lost much of its support, 

 sinks, dragging with it the roof of the vagina and the uterus. It is said 

 that the displacement sometimes occurs when a woman jumps from a 

 height, carries too heavy a weight, or in some other way overtaxes the 

 attachments of the womb. 



In retro version the fundus impinges against the rectifm, imped- 

 ing defalcation and causing 

 tenesmus. Retroversion is 

 apt to be found in women 

 who have borne children, 

 and especially so if, after 

 labour, they have been too 

 highly and persistently 

 bandaged and kept too 

 long lying supine. The con- 

 dition is detected both by 

 vaginal and rectal exami- 

 nation. In one case the 

 pressure against the rectum 

 was diagnosed as a 'malig- 

 nant obstruction,' for the 

 relief of which colotomy 

 was most unfortunately 

 performed. 



In retroflexion the body is bent towards the sacrum, the fundus 

 filling into Douglas' pouch, where it may be felt by the finger in the 

 rectum or vagina ; the introduction of the sound shows that the mass 

 is not a uterine tumour or a hiumatocele. 





Retroversion. (FARRE.) 



