Anteflexion.—An exaggeration of the normal forward bend of the uterus is met with fairly commonly. It is often associated with under development of the cervix (conical cervix), and by many it is assumed to have a causal connection with some cases of dvsmenorrhcea (q.v.), and of sterility. For the relief of these conditions it has been suggested by some specialists that a hollow intra-uterine stem should be worn, hut there is little evidence that such an appliance serves any useful purpose. If these symptoms are present in a case of anteflexion, relief is as likely to be obtained from dilatation of the cervical canal up to 12 or 14 ITegar as from any more elaborate method of treatment. If no such symptoms are caused by the condition, no treatment should be instituted.
Chronic Inversion.—When an acute inversion of the uterus (see under Post-Partum Haemorrhage) has not been diagnosed or reduced until the uterus has involuted, the main symptom is hmmorrhage, which may be confined to the menstrual epoch, or may recur at irregular intervals. In addition, the patient often complains of something coming down, and a mucoid or leucorrhceal discharge is usually present. A careful bimanual examination will show the nature of the case, and will distinguish it from a fibroid polypus, a cervical fibroid, or inversion due to a fibroid tumour, the conditions with which it is most likely to be confounded.
It is probably useless in any of these cases to attempt reduction by manual taxis, even under an amesthetic, and harm may be done by too violent manipulation. Steady elastic pressure exerted by means of Avelim(s or Lawson Tait's repositors is likely to be effectual. A re positor is chosen of a size which will permit the fundus to lie snugly in its cup. Should the vagina be very lax, it is advisable to pack lightly with iodoform gauze around the instrument, so as to prevent it from shifting off the fundus. The elastic cords on the stem of the repositor are then attached to a waisthelt so as to exercise moderate pressure, and the apparatus is left in place for 21 hours. At the end of that time it is removed and readjusted. The method should be given a trial of at least a week's duiation, adjustment being renewed daily. Should this fail, recourse must be had to operation. The best results seem to have been obtained by incising the cervix through an abdominal incision and then reins erting the fundus.--R, J. J.