The pathology, diagnosis, and treatment of diseases of women : including the diagnosis of pregnancy / by Graily Hewitt.

  • Hewitt, Graily, 1828-1893.
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: The pathology, diagnosis, and treatment of diseases of women : including the diagnosis of pregnancy / by Graily Hewitt. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    important influence in the production of one of the forms of flexion of the uterus. I mean anteflexion. In the case of young women, employed in dressmaking establishments, and following their occupations for many hours during the day, without any oppor- tunity of taking exercise, combined not seldom with bad living, there are thus brought into play the predisposing causes also. It is not at all rare to find, under such circumstances, that the uterus becomes anteflexed. The use of sewing machines I have observed to be followed by the same result. This is due to the position of the body. A word more in reference to pregnancy as a cause, We frequently find in practice that patients attach ex- treme importance as regards the commencement of their maladies to their confinements, suspecting the illness to be due to some peculiarity in the confinement itself. As will be more parti- cularly shown in the chapter on 6 Prolapsus,' destruction of th e normal support given by the perineum, such as sometimes occurs in the act of labour, is often the starting point of prolapsus and flexion ; but flexion may originate without injury of the perineum. How, it may be asked, does the fundus of the uterus descend forwards or backwards, as the case may be ? It descends in consequence of the pressure from above when a sudden or forcible exertion involves putting the abdominal muscles into a.state of rigidity. The viscera of the a,bdomen receive the pressure, and that which offers the least resistance, of course, will give way. It is a matter of accident whether the fundus moves forwards or backwards. That is determined by other conditions* We pass now to the study of the varieties of flexion of the uterus. Supported as the uterus is at each side, lateral flexion is very rare. The uterus is generally either bent forwards or back- wards, constituting in one case anteflexion, in the other retro- flexion. With reference to the comparative frequency of these two events, the following is, I believe, the truth on the subject. Anteflexion of the uterus is more common than retroflexion, and in the proportion of about three to two; but severe anteflexion is more rare than severe retroflexion. A consideration of the attach- ments of the uterus gives the clue to this. Fig. 33 represents the normal shape of the uterus, and the position of the bladder. It is seen that the peritoneal pouch behind the uterus (c) is much deeper than that in front of it (a). There is, in fact, less support for the uterus behind than there is in front. When the fundus gets bent backwards, it will be seen that there is more room for