A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Science
A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Medicine -- Practice
Fig. 2 represents, according to Schultze,[2] the location and position
of the virgin uterus and its surroundings, the bladder, rectum, and
vagina being empty and collapsed. The angle of about 90° which the
cervix forms with the vagina measures the forward inclination of the
cervix, but is subject to slight variations in consequence of the
physiological {149} movements of the uterus. The body is furthermore
bent forward upon the cervix, so that its anterior surface rests upon
the empty bladder. The angle of the normal anteflexion, according to
careful measurements by Schultze, is about 48°; Fritsch says that 90°
is the physiological limit. This question will be further considered
under the subject of pathological anteflexions.
[Footnote 2: _Archiv für Gynäkologie_, 1875, Band viii. p. 134, and
_Lageveranderungen der Gebarmutter_, Berlin, 1881.
Ely Van de Warker makes a full and critical study of the normal
movements of the unimpregnated uterus in the _N. Y. Medical Journal_,
xxi. p. 337, and of the normal position and movements of the
unimpregnated uterus in the _American Journal of Obstetrics_, xi. p.
314. His conclusions substantially agree with those of Schultze.
Frank P. Foster (_American Journal of Obstetrics_, xiii. p. 30)
presents a valuable paper giving a résumé of the literature, with
original observations, in which he takes exceptions in part to the
views of Schultze.]
[Illustration: FIG. 2. The Correct Representation of the Pelvic
Organs.]
Normal Movements of the Uterus.
Strictly, the uterus can have no absolutely normal position or
location, because it has a certain normal range of movements which
depend to some extent upon respiration, intra-abdominal forces, and
locomotion, but more especially upon the varying quantity of material
in the rectum and bladder. Its normal position, then, varies within the
limits of its normal movements. If the body of the uterus rest upon the
bladder, it must rise as the bladder becomes distended, and,
conversely, if the urine be drawn through a catheter while the woman is
lying on her back, the uterus, notwithstanding the opposing influence
of its own weight, immediately follows the receding wall of the bladder
and returns through an angle of 45°, or possibly even 90°, to its
accustomed position. The dotted lines in Fig. 2 indicate the degree of
version and flexion consequent upon the varying quantity of fluid in
the bladder.
{150} The full rectum forces the uterus in the opposite direction,
toward the symphysis, and thereby counteracts the influence of the
bladder. This anterior movement is, however, somewhat limited, and is
confined to the cervical portion, except when the body has been forced
back into close proximity with the rectum by the over-distended
bladder.
Normal Supports of the Uterus.
The uterus is maintained in its normal position and location by the
following agents:
_a_. The uterine ligaments;
_b_. The pelvic floor.[3]
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