| FIG. 1. |
| The Classical Representation of the Pelvic Organs. |
Again, suppose the uterus (Fig. 1) to be carried bodily upward and backward, its axis remaining the same, until the cervix reach its normal position near the hollow of the sacrum; then would the body of the uterus impinge upon the bony sacrum. It is therefore clear that the anteversion must be the normal position, because the uterus and sacrum would otherwise occupy the same space.
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 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.
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.
| 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.