Femina, A Work for Every Woman

by John A. Miller

CHAPTER XVIII.

THE NATURAL POSITION OF THE UTERUS AND HOW IT IS SUPPORTED.

The uterus is not a stationary fixture in the female pelvis, but enjoys a mobility within physiological bounds, which in itself explains the great diversity of opinions which may and do arise respecting the normal or abnormal position of the womb in any given case.

When the surrounding organs and tissues of the womb are in a healthy condition, and the abdominal walls are not compressed by the weight and pressure of skirts, nor the liver or diaphragm forced down towards the pelvis by a tight-fitting corset, the organ is movable in every direction, without the slightest pain or suffering.

The uterus is not tied down by any ligaments, as one might imagine from a description of the several ligaments that constitute only in a small degree its support, for it changes its position in retching, coughing, breathing, singing, walking and all other violent movements.

The question now naturally arises: What is the normal position of the uterus, and what constitutes its natural supports? To answer this interrogation is to controvert one of the most baneful fallacies in gynecological practice, for the amount of torturing and useless doctoring to which women are constantly subjected, owing to some fancied displacement of the womb, illustrates the force of precedent or of accepted opinions, that were fortified by years of erroneous teaching.

It was supposed until quite recently that when the body of the womb was inclined horizontally forwards, this was unnatural or a sign of disease, until Prof. B. S. Schultze, director of the gynecological clinic of Jana, successfully controverted this doctrine. In his work “Die Pathologie und Therapie der Lageverænderungen der Gebærmutter,” which is the most classical work extant on displacements of the uterus, says: “From the post-mortem findings it was inferred that the uterus occupied in the living woman the same position as in the cadaver; such an assumption did not take into account the actions of the muscles on the position of the uterus in the living subject nor the intra-abdominal pressure which is entirely absent after death, so that the dead organ naturally gravitated backward after the remains had lain for several days on the back.” Another observer, Dr. Hach, found in a number of cases that he had examined during life, the uteri bent forward or antiflexed; twenty-four hours after death he discovered the same uteri in an opposite direction or retroflexed.

This and similar subsequent researches have demonstrated the fact that when the body of the womb rests on the bladder it is not in an abnormal position as formerly supposed and called anteversion or anteflexion, but that it is natural for it to be so, and when the body is elevated and its axis forms an obtuse angle with the horizon, the inclination is a post-mortem condition.

With these precursory remarks I am now able to answer the first clause of our query, and would say that the uterus is in its normal position when its long axis is nearly parallel to the horizon or at right angles with the perpendicular or long axis of the body. The normal position of the uterus is modified when the bladder is full or distended, for this lifts the body of the uterus upwards, thus temporarily making an acute angle with the vertical axis of the body, which was formerly considered to be the permanent and natural pose of the organ.