Treatise on gynæcology : medical and surgical . takes the position while it is still soft and yielding, andmaintains it because its normal tonicity fails to return. Then thereare adhesions formed and the uterus becomes fixed. The presence ofa tumor which by its weight causes the deviation is only of second-ary importance. 420 CLINICAL AXD OPERATIVE GYNECOLOGY. [Anteversion being but an exaggeration of the normal position, butrarely causes symptoms or needs treatment except when complicatedby parametritic adhesions or contraction of the utero-sacral bands,which markedly limit its mobility. In a
Treatise on gynæcology : medical and surgical . takes the position while it is still soft and yielding, andmaintains it because its normal tonicity fails to return. Then thereare adhesions formed and the uterus becomes fixed. The presence ofa tumor which by its weight causes the deviation is only of second-ary importance. 420 CLINICAL AXD OPERATIVE GYNECOLOGY. [Anteversion being but an exaggeration of the normal position, butrarely causes symptoms or needs treatment except when complicatedby parametritic adhesions or contraction of the utero-sacral bands,which markedly limit its mobility. In a limited number of cases ofanteversion, with marked relaxation of the uterine supports and de-scent when in the erect position, the ring rjessary may be needed asadvised below.] Symptoms.—The uterine syndroma which I have described indiscussing metritis reappears here in all its characters. The rectaland vesical tenesmus are especially noteworthy, are exaggerated by thepressure of the uterine body and neck, but yet may be absent or &J 1. Fig. 209.—Anteversion. may exist with simple metritis. The nervous reflexes which result aredue to the uterine mobility and the entero-ptosis which it causes morethan to the mere displacement, which is demonstrated by the effec-tiveness of immobilization by means of the pessary. Diagnosis.—The diagnosis is easily made clear by bimanual palpa-tion. The finger in the vagina seeks for the cervix far in the rear, then,carried forward, feels the body of the-organ through the anterior cul-de-sac and may follow its anterior surface, while the hand placed abovethe pubes examines the posterior, placed horizontally. The passageof the uterine sound is usually difficult and is seldom necessary. Itshould be employed only when there is any doubt as to the nature ofthe tumor felt in the anterior vaginal pouch, or if the fundus cannotbe differentiated from a tumor above it, such as a fibroma or an in-flammatory or hemorrhagic exudation. Anteflexion may
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