From a practical point of view the only two displacements of much importance are backward displacement—retroversion--and downward d ispl acem en t—pro/apse. A true anterersion can only take place in the case of a pregnant uterus in the later months of pregnancy, when it may sag fore anis if the abdominal wall is relaxed (see under Pregnancy, Disorders of). A lateral displacement occurs under two sets of circumstances, when a tumour in nne broad ligament (e.g., a parametritie exudate) pushes the uterus over towards the opposite side of the pelvis, or when the nntraction of the newly formed connective tissue, as an xudate, becomes organised. pulls the uterus over towards the same side. The uterine axis may lose the normal curve, and may become either straightened out, bent forwards at inure or less of an angle—antejlexion or bent backwards-- rdroflevion. The walls of the vagina may share in the descent of the uterus, or may be affected alone, and as such an affection is often, though inaccurately, termed by the laity " falling of the womb," it will he considered in this article. Either the anterior vaginal wall, with the base of the bladder, may bulge into the vulva (cystocele), or the posterior with the rectum Owlarrle). Lastly, I shall describe the treat went of that rare form of uterine displacement, chronic inversion ; the acute form has already been dealt with under Puerperal Hemorrhages.
Retroversion.—The cervix is anchored to the sacrum on each side by more or less well-developed bands of connective tissue forming part of the pelvic fascia, and is thus prevented from descending towards the vulva. The fundus is pulled forwards on each side by the round ligaments, which are muscular and elastic, hut unable to resist long-continued strain. In cases of retroversion without prolapse the round ligaments are relaxed; when the sacral ligaments are poorly developed or have yielded to the stresses thrown on the lower uterine segment and cervix at childbirth, descent of the uterus accompanies the retroversion. The treatment of the latter class of cases will be more fully considered under the heading of Prolapse.
Retroversion without prolapse is found in women of all ages, in those who have borne children and in virgins.' When one considers that in the course of a gynecological examination a retroversion is not infrequently discovered, to which none of the patient's symptoms can fairly be attrib uted, and that again a patient's symptoms may be relieved by curing some coincident condition, such as endometritis, though nothing is done to replace the uterus in its normal position, one is tempted to doubt whether retroversion per se is capable of giving rise to symptoms at all.
But we must remember that the abnormal position of the uterus in itself predisposes to congestion, with consequent increase in the weight and bulk of the organ, and increased liability not only to microbic infection setting up a true endometritis, usually in the cervix, but also to that hypertrophy of the endometrium often associated with capillary dilata tion and known variously as " fungoid," " polypoid," or " hemorrhagic endometritis," which provides such a wide field for the victories of the curette. It is not uncommon to find one or both ovaries enlarged and prolapsed in a case of retroversion.
When a retroversion is discovered in the course of a pelvic examination, arid when the uterus is free from any other pathological condition, the practitioner should seriously ask himself before commencing any special treatment whether the patient's symptoms can be fairly referred to the displaced uterus, for time and skill will only he wasted in attempting to cure symptoms due to neurasthenia, anaemia or debility by measures directed solely to the restoration of the misplaced organ to a normal position.
In the average case of retroversion with symptoms of sacral pain or dragging, leucorrhcea and menorrhagia, the best plan is to commence by a course of treatment directed to the relief of any pelvic congestion or uterine inflammation present. Glycerin of Subitol (1 o per cent.) or Boroglyceride tampons should he inserted in the vagina once a week. and hot antiseptic or astringent douches (1 in io,000 Perchloride, half saturated Boric Acid, weak Permanganate, drachm to the quart Sulphate of Zinc) given daily. (See also under Endometritis and Leucorrhcea.) The patient's general health should be attended to, for rest, tonics and change of air all play a part in the cure of such symptoms. Many of these cases are much improved by curetting, which relieves the congestion, gets rid of diseased mucous membrane, and by the week or so of enforced rest often gives the patient a start on the road to recovery.