RETROVERSIO UTERI. 



examination with his finger, he finds the fundus of the uterus 

 inclining forwards towards the os pubis over the fundus of 

 the bladder ; while the os tines is carried backwards towards 

 the facrum, upon the middle of the reftum, fometimes fo 

 hioh up that it can hardly be reached with the finger. The 

 patient has generally a conftant inclination to make water ; 

 preflure juft above the pubes always gives her confiderable 

 pain ; whenever (he gets up to walk, (lie is confeious of a 

 hard fubftance falling upon the bladder, and obliging her to 

 empty it ; and, when (he lies down upon her back, flic feels 

 the fame hard body flip back again. In one example, a pa- 

 tient had fuch pain in the abdomen and foft parts, that flie 

 could fcarcely move. 



In general, the anteverfion of the womb may eafily be 

 remedied. The patient being laid upon her back, which is 

 to be fomewhat raifed up, the furgeon is to apply his hand 

 above the pubes, and make preflure there, by which means 

 the fundus uteri will be forced backwards, and the os tines 

 inclined forwards into its natural fituation. A recurrence 

 of the difplacement is to be prevented by the application of 

 a pefi'ary, which will fupport the os tineas. The patient is 

 to be kept for a certain time upon her back in bed, and a 

 tight bandage fhould always be put round the body juft 

 over the os pubis. The uterus by degrees commonly be- 

 comes fixed again in its right pofition, lo that the ufe of the 

 peflary can be difcontinued. The inftrument muft not be 

 left off too foon, however, left a relapfe fhould be the 

 confequence. 



In the retroverfion, the pofition of the womb is altered 

 in a manner preciiely the reverfe of what occurs in the fore- 

 going cafe. The os tinea: lies towards the pubes ; while 

 the fundus uteri is carried towards the facrum, and is gene- 

 rally funk fo far down betwixt the vagina and the reftum, 

 as to occafion, at the pofterior part of the former canal, a 

 protuberance, which clofes it, and which at the fame time 

 comprelles the reftum in fuch a manner, that the patient 

 cannot void her feces, nor can clyfters be adminiftered. As 

 in this preternatural pofition of the uterus, the bladder and 

 meatus urinarius are unavoidably diiplaced, the cafe is al- 

 ways complicated with a retention of urine, which is the 

 more afflicting, as it is ufually very difficult, and even im- 

 practicable, to introduce a catheter. The opening of the 

 meatus urinarius is fometimes drawn fo high up, that it is 

 actually higher than the pubes. Hence, the anterior pa- 

 rietes of the vagina are conltantly very much ftretched. 

 When the retention of urine has laited a certain time, the 

 os tincse above the pubes cannot be reached nor touched 

 with the end of the finger. In this circumftance the blad- 

 der forms, beneath the os tincae, a large fwelling, which 

 hinders the finger from feeling the latter opening. The 

 patient always luffers exceffive pain, which not unfrequently 

 refembles that of labour, and arifes partly from the impedi- 

 ment to the evacuation of the urine, and partly from the 

 difplaced condition of the parts. The diforder, therefore, 

 has often been mifunderftoou, the patient's fufferings being 

 regarded as labour-pains, and delivery expedied. Indeed, 

 when the complaint is not Ipeedily removed, a mifcarriage 

 is the confequence. The cafe is frequently attended with 

 fever and inflammation. 



The retroverfion of the uterus has never been obferved, 

 except in pregnancy, and always in the fecond, third, or 

 fourth month of that ftate. It is moft apt to occur in fuch 

 women as have a wide pelvis. Fat fubjedts are more liable 

 to the diforder than thin. It is obferved to be brought on 

 by bodily exercifes and exertions, as, for inllance, by violent 

 vomiting, falls, the lifting of heavy burdens, &c. But, 

 Richter thinks it unlikely, that the cafe (hould arife and be 



9 



fuddenly produced by thefe caufes alone. How, he aflcs, 

 could the gravid, round, diftended uterus be thus fuddenly 

 difplaced, and become deprefled betwixt the redtum and the 

 vagina ? He conceives it probable, that a predilpofition to 

 diforder, or rather an incipient ftage of it, muft have exifted. 

 He thinks it likely, that the occurrence of the complaint 

 may be promoted by repeatedly nagledting to make water, 

 and by the confequent diftention of the bladder, whereby 

 not only the fundus uteri is prelled towards the facrum, but 

 alfo the cervix becomes drawn upwards. Richter believes, 

 that a fmall degree of retroverfion, that has exilted a good 

 while, may only be increafed by the caufes already hinted at, 

 fo as to excite notice ; and that the fundus of the uterus 

 may now foon be forced by the efforts, refembling thofe of 

 labour, fo far down between the vagina and the rectum, that 

 all thefe parts become as it were adherent together. The 

 foregoing ftatement Richter thinks the more likely to be 

 corrett, inafmuch as cafes have actually been obferved, 

 where patients have experienced various (light complaints a 

 confiderable time before the retroverfion was known to 

 exift ; but which complaints might be afcribed to the in- 

 cipient ftage of that fort of difplacement of the uterus. 

 How it happens, that retroverfion of this organ is only met 

 with in the early months of pregnancy, is eafy of comprc- 

 henfion. The retroverfion is promoted by the weight of the 

 gravid uterus. During the latter half of the period of 

 geftation, however, the uterus is too large to be capable of 

 defending betwixt the vagina and redtum ; and the occur- 

 rence of retroverfion, except in pregnancy, is what can 

 hardly be conceived. 



The furgeon lhould always endeavour to put the retro- 

 verted uterus, as foon as poffible, into its natural pofition 

 again. The longer the retroverfion has lafted, the more 

 difficult it is of removal, and the more preffing are the 

 dangers, of which there is caufe for apprehenfion. The 

 moft urgent peril arifes from the retention of the urine, and 

 the ftoppage of evacuations from the bowels. The longer 

 thefe functions are obftrudted, and the more the urine and 

 feces accumulate, the more violent do the painful labour-like 

 efforts become, whereby the fundus uteri is continually 

 preffed more and more deeply downwards. Befides, the dii- 

 tention of the redtum and bladder operates itfelf as an im- 

 mediate impediment to the redudtion of the uterus. Pa- - 

 tients have been known to lofe their lives in confequence of 

 the bladder giving way. Sometimes abortion happens ; and 

 very often the confequences of fuch an event are favourable; 

 the urine foon afterwards being fpontaneoufly voided, and 

 all the complaints fubfiding. (Saxtorph, Collettanea Hav- 

 nierifia, vol. ii.) The diforder, however, has been known 

 to continue eleven days, and yet admit of being removed in 

 the moft favourable manner. 



In difficult cafes, the reduction of a retroverted uterus 

 may be facilitated by previoufly emptying the redtum and 

 bladder ; an object which is frequently practicable. The 

 diftended bladder not only renders the redudtion difficult, 

 but is attended with fome danger of that organ burfting in 

 the operation, which often requires the exertion of confi- 

 derable force, efpecially when the bladder is very much di- 

 lated. Hence, before attempting the reduction, the fur- 

 geon is called upon always to endeavour to draw off the 

 urine. When the bladder has been emptied, the retroverted 

 uterus fometimes fpontaneoufly returns into its natural pofi- 

 tion, as feveral cafes on record have proved. ( Hunter and 

 Chelton in Medical Communications, vol. ii. ; Croft in Lon- 

 don Medical Journal, vol. xi.) Such facts muft fully con- 

 vince us, how much the redudtion may 'be facilitated by 

 drawing off the urine in the firit initance. A catheter may 



frequently 



