me to bring them here, that they may be more thoroughly and severely criticised. I beg to thank the Society for their kind attention. Dr. GRAILY HEWITT had listened with much pleasure to Dr. Squarey's paper, and he thought the explanation given by the author of the fact that strains and accidents sometimes produce anteflexion, and at other times retroflexion of the uterus, ingenious and satisfactory, and that Dr. Squarey had supported those views in a very able manner. In reference to a suggestion made by the author, that laceration of the uterine muscular tissue actually sometimes occurred, and that this was the first step in the atrophy of the wall found in some cases of flexion, he was disposed rather to look on this atrophy as the result of the pressure produced by the flexions; pathological facts were wanting to support the author's hypothesis in that particular. Dr. ROUTH said he did not agree with all Dr. Squarey's conclusions, although he could not but admit them. First, in regard to anteflexions. They were more common in young unmarried people, not necessarily because the uterus was high up, but because in these the normal uterine position was one of partial anteversions, converted at once into anteflexions by fatigue, long walks, falls, &c. Anteversions occurred also in uteri high up. Retroversions were more common in older women, not necessarily because the uterus was low down, but because in cases of uninvoluted or congested uteri (the fundus being the part chiefly top heavy, and the patients generally selecting to rest themselves in position on the back) the top heavy organ naturally fell backwards. These flexions often depended also on the position taken by patient. He had seen that by urging a patient to lie not on her back but on her belly a retroverted organ became anteflexed, and yet in both the uterus was low down; but it was in favour of Dr. Squarey's view (and which could be realised in most cases if watched from day to day) that the uterine congestion once relieved by leeching and other depletive measures, and become lighter, the retroflexed organ might become anteflexed. But as women grew older, whether married or not, and in whom uterine congestions occurred, anteversions were not uncommon, although retroflexions most complete, and yet in both the uterus was low down. Dr. HEYWOOD SMITH said that although the experience of others seemed to be different, yet in a large out-patient practice he had found that among the unmarried and sterile anteflexion was the most frequent flexion; and though cases of retroflexion were found in the nulliparous, it was nevertheless comparatively rare. Dr. BANTOCK was not prepared to accept the explanation of the causation of flexions of the uterus offered by Dr. Squarey. He had seen a considerable number of cases of retroflexion at all periods of menstrual life without presenting the necessary conditions. He agreed with Dr. Routh in assigning the relative greater frequency of anteflexion to the natural tendency to that condition in the young subject. He could not at all accept Dr. Squarey's theory as to the cause of traumatic anteflexion. A force applied to the posterior aspect of the fundus uteri would necessarily cause rupture of tissue (assuming such an accident to be possible) on the concavity of the bend, i. e., on the posterior aspect of the junction of body and cervix. The swelling from effused blood, &c., would doubtless at first cause the uterus to bend forwards, but the subsequent atrophy of ruptured muscular fibre and contraction of fibrous tissue wou'd reduce the primary displacements, and lead to the opposite condition, the thinning of the concave aspect, described as existing in anteflexion being necessarily on the opposite side. The PRESIDENT, after complimenting the author upon his first and very carefully written paper, thought that hardly sufficient stress had been laid upon the action of the bladder in the production of retroflexion. He pointed out that the antagonists to the backward displacement of the fundus by a full bladder were the round ligaments. If these were relaxed or overstretched, and the attachment of the neck of the uterus to the base of bladder, and by it to the symphysis pubis remained firm, then the distension of the bladder acting for a long time, as in women who hunted, or were unable from other circumstances to micturate, would tend to cause retroflexion. This effect would be added to by the straining of constipation or other exertion. Dr. SQUAREY replied, in answer to Dr. Graily Hewitt, that he thought that atrophy of tissue from pressure at the point flexed was more likely to occur if the tissue had been injured at that part than if not. Atrophy had been proved to exist at this spot, but whether it originated in healthy or bruised tissue had not been proved. To Dr. Murray,-that this paper was not intended to discuss the relative frequency of anteflexion and retroflexion, at the same time his experience quite agreed with what Dr. Murray stated, retroflexions being much the most frequent; but when a retroflexion occurred in a young unmarried woman, the history of her case would always reveal the existence of predisposing causes to flexions, as anæmia, constipation, leucorrhoea, &c., all of which tended to cause a certain amount of prolapse of the uterus, with the consequent alteration in the direction of the uterine axis. In answer to Dr. Routh, Dr. Squarey said that he did not for one moment believe that lying on the back had anything to do with the production of retroflexion. He did not believe that it alone would ever cause it, however much a woman might be predisposed to flexion. Again, with regard to pressure downwards by the intestines, he did not believe they exerted pressure to a sufficient extent either to cause a flexion, or to maintain one after it had been caused; always containing more or less air, he believed the intestines to be almost self-supporting. And in answer to Dr. Braxton Hicks, he stated that the round ligaments being inserted into the cellular tissue over the pubes, he did not think, as this was not a fixed point, that occasional distension of the bladder would cause stretching of them to such an extent as to favour retroflexion. INDEX. Abdomen, systematic examination of, for rectifying malposi- Abortion, on retroflexion of the uterus as a frequent cause of (Dr. Phillips) Acephalous monster (Mr. J. Milward) Address of the President (J. Braxton Hicks, M.D., F.R.S.), PAGE 331 337 45 140 25 Amputation of inverted uterus on account of hæmorrhage (Dr. H. Davis). 104 1, 19 Annual General Meeting, January 3rd, 1872. 102 on post-mortem parturition, with references to forty-four Report on Dr. Meadows's case of extra-uterine fœtation BANTOCK (Dr. G. G.) specimen illustrating the changes in the on the treatment of certain forms of menorrhagia and Remarks on the origin of ovarian cysts from the par 2 84 43 on Dr. Phillips's paper on retroflexion as a cause of 53 . on Mr. Bryant's case of extirpation of uterus and 82 abortion BANTOCK (Dr. G. G.), on the removal of ovarian cysts by on Dr. Squarey's paper on the causes of flexion of Barker (Dr. Fordyce) election as an Honorary Fellow fibrous tumour from the anterior wall of vagina. PAGE 343 359 259 108 127 309 309 mode of dealing with the placenta where gastrotomy is Remarks on retroflexion as a frequent cause of abortion on the various causes of dysmenorrhea 325 56 62 102 on Dr. Newman's case of natural pregnancy subse- on Prof. Simon's scoop for removing superficial on the rarity of entire absence of uterus or ovaries. on the danger of removing the placenta in operation for extra-uterine pregnancy BASSETT (Mr. John) cases in practice: accidental hæmorrhage, BECK (Dr. Snow) case of pelvic hæmatoma or retro-uterine rupture of a varix in the genital organs during preg- 60 61 62 Discussion on ditto 260 . 279 |