Mollities Uteri. 
BY 
CHARLES D. SCUDDER, M.D. 
REPRINTED FROM 
5TI)e Nell) Yovfc jWetiical journal 
for December IS, IS86. Reprinted from the New York Medical Journal 
for December 18, 1886. 
MOLLITIES UTERI * 
By CHARLES D. SCUDDER, M. D. 
Four years ago a nulliparous patient suffering from 
marked anteflexion of the uterus presented herself at my 
clinic in the Demilt Dispensary. She returned shortly 
after with an evident retroflexion of the organ, and in the 
course of the next half-year this alternate anteflexion and 
retroflexion showed itself repeatedly. The infra-vaginal 
part of the cervix and the body were normal, so I decided 
that the supra-vaginal cervix, and that portion of uterine 
tissue immediately above it, were in an atonic or softened 
condition. Close study, and later on a careful history of 
cases, showed that this atony was by no means rare. A 
series of observations was made which may help in clear- 
ing up still further the question of uterine pathology, and 
which will be of unquestionable interest to this society as 
throwing light on a few questions of prognosis and treat- 
ment in patients suffering from certain varieties of uterine 
affections. 
The supra-vaginal cervix, and that portion of the uterus 
containing the internal os, will be called the middle seg- 
ment of the uterus as distinguished from the cervix—that 
part observed by the aid of the speculum—and the body 
or upper third of the organ. Mollifies suggests itself as an 
* Read before the New York Clinical Society, October 22, 1886. MOLLITIES UTERI. 
2 
excellent term wherewith to designate the extraordinary 
softness which sometimes atFects the uterus. From the 
time the case referred to above was treated to the present 
a large number—about one hundred in all—have been 
recorded, and fully two hundred more patients have been 
seen, who collectively furnish sufficient material to present 
results from a clinical standpoint. The writer takes the 
liberty of limiting his statements to his own experience, as 
the literature on this subject is diffuse and unsatisfactory. 
Every one is familiar with the mollities of the cervix 
that appears in pregnancy. If the middle segment of a 
pregnant uterus is carefully examined, an evident softening 
will frequently be detected. The examining linger can in- 
dent the uterine tissue, and the fundus can be raised and 
depressed without moving the cervix. This sign of the 
early weeks of pregnancy is valuable, although it is neither 
invariable nor infallible. Mollities will also be found— 
rarely, however—in the body of a gravid uterus. Such 
uteri are so soft that the transverse diameter is often en- 
larged, and the antero-posterior diameter so markedly di- 
minished that the foetus apparently lies with its length 
directed transversely in a soft sac, which can be molded 
by the hand, and which may allow—as noted in one case— 
the utmost perfection in the determination of position when 
confinement is close at hand. In the case just mentioned, 
the abdominal walls being thin, the recti muscles being 
separated, and the child lying in the softened fundus of an 
anteflexed uterus—the whole mass forming a large hernia 
and hanging half-way to the knees—it was somewhat diffi- 
cult to decide whether an extra-uterine pregnancy was not 
present. Again, mollities affects the whole gravid uterus. 
The order of frequency in the gravid uterus seems to be 
mollities of the cervix, of the middle segment, of the body, 
and of the entire uterus, MOLLITIES UTERI. 
3 
This same softness exists as a diseased condition in both 
nulliparous and multiparous women. The cervix may be 
very soft, the middle segment may be atonic, the body may 
be the site of this disease, or mollities may affect the whole 
uterus. The diagnosis can readily be made. A softened 
cervix is at once appreciated by the examining finger. A 
softened middle segment can be detected by raising the 
body of the uterus with the vaginal finger and depressing 
it with the abdominal hand. If mollities of the middle 
segment exists, the body will readily be moved without a 
change of axis in the cervix, showing that an exceedingly 
soft tissue lies between the body and the cervix. Mollities 
of the body is easily diagnosticated, if one has acquired 
skill in examination, by the readiness with which it can be 
molded. There is also a characteristic lack of definition in 
the uterine body which confuses many who are not prac- 
ticed in conjoined manipulation. When the uterus, as 
such, is softened, definition is almost entirely lost, and the 
organ feels like a thick, wet dish-rag. 
In point of frequency, I have found mollities of the 
middle segment to be most common in the nulliparous and 
in the multiparous non-gravid uterus ; next, mollities of the 
fundus ; then mollities of the cervix ; and that of the whole 
uterus most infrequent. 
Mollities seems to be due to malm; trition of the body as 
such, and of the uterus in particular. Bad hygiene in the 
matters of exercise, ventilation, food, rest, clothing, etc., 
tends to produce a lack of vigor, which finds local expression 
in an atonic uterus. This cause may be considered as a 
predisposing and also, in some cases, as an exciting cause 
of mollities. Changes in uterine nutrition induced by (a) 
congestions, or inflammations of the uterus, ovaries, or sur- 
rounding tissues and organs, and (b) by pregnancy, neo- 
plasms, etc., act as potent factors in producing this condi- 4 
MOLLITIES UTERI. 
tion. So that it may sometimes be secondary to uterine 
disease, but often a primary cause of uterine disease, when 
it involves either the body or the middle segment of the 
uterus. It seems clear to me that mollities of the middle 
segment, produced by systemic depression, is the starting- 
point of a large number of uterine and ovarian diseases. 
Advancing from clinical diagnosis to clinical pathology, 
mollities of the cervix presents nothing of interest; that of 
the fundus and of the entire uterus exhibits the phenomena 
of sluggish circulation and complete atony; but when the 
middle segment is affected, a most interesting chain of 
phenomena, due to the results produced by this softening, 
will be seen. A young nulliparous woman presents herself, 
complaining of general ill-health and of bearing down when 
exercising. She has paid no attention to the laws of 
health, either through force of circumstances, ignorance, or 
carelessness, and complains of loss of appetite, costiveness, 
headache, fatigue on rising in the morning, general languor, 
etc., in addition to pelvic distress. An examination shows 
an atonic middle segment, and nothing else. Simple treat- 
ment i4* proposed and successfully carried out. Later on she 
may return. Cross-examination shows that proper hygiene 
has again been neglected. The symptoms complained of 
previously have returned, with the addition of increased dis- 
comfort on exertion and painful menstruation on the first 
and second day. Conjoined manipulation now shows a well- 
marked anteflexion, with a softened middle segment. If 
this is not relieved by proper treatment, the flexion will be- 
come very marked. Frequent micturition and troublesome 
uterine dysmenorrhoea will add themselves to the other 
symptoms, and later on ovarian dysmenorrhoea will develop. 
The body of the uterus will be found enlarged and sensi- 
tive. Menorrhagia and sometimes metrorrhagia will appear. 
The ovaries become sensitive and subsequently enlarged. MOLLITIES UTERI. 
5 
This represents a natural pathological series of phe- 
nomena, which present themselves in different stages to the 
notice of physicians. The multiparous patient differs only 
in that she generally starts with a subinvoluted uterus, 
the heavy body of which flexes itself far more readily than 
that of the unimpregnated uterus, if mollifies of the mid- 
dle segment is present. But the subjective and objective 
symptoms are about the same. The flexion seems to be 
determined by the position of the uterine axis. If this in- 
clines backward, a retroflexion can be inaugurated by any 
over-exertion. If it inclines forward, an anteflexion is likely 
to take place. Of course, if the flexions are not restored 
naturally, or by the aid of the physician, they will in time 
become fixed, and mollifies will give place to a hardening of 
uterine tissue. 
The prognosis of mollifies is generally good if no ex- 
hausting disease of other vital organs is present and if hy- 
gienic regulations can be carefully observed. If a flexion 
exists with mollifies of the middle segment, the conditions 
are most favorable for its relief, as this softness allows of 
easy reduction, and treatment can be adopted which will 
maintain the body of the uterus in its normal position and 
restore tone to that organ. 
Treatment must be constitutional and local. Appropri- 
ate food, proper exercise, a correct attitude, free-fitting cloth- 
ing, lying quiet at least one hour a day, breathing pure air> 
etc., must be insisted upon in every case. Quinine, aloes, 
capsicum, and nux vomica have proved to be excellent 
uterine tonics. The bowels should be carefully regulated 
with fruit, vegetables, and water. If costiveness is ob" 
stinate, the following recipe for bran biscuit will often be 
efficacious : 
Take of bran, one quart; flour, one pint; milk, one 
pint; molasses, eight tablespoonfuls; baking soda, two tea- 6 
MOLLITIES UTERI. 
spoonfuls. Mix. Bake as soda biscuit. One or two at 
each meal. 
If these fail, cascara, aloes, etc., must be employed. 
Flexions should be restored by digital reposition, the pa- 
tient lying on her back in anterior displacements, and be- 
ing placed in Sims’s, or preferably the genu-pectoral posi- 
tion, if she suffers from retroflexion. Resting ten minutes 
three times a day in the genu-pectoral position relieves and 
assists in the cure of both anteflexions and retroflexions, 
when atony of the middle segment exists. Reposition with 
the Sims or Elliot repositor can readily be accomplished, and 
pessaries suitable to each case, or even cotton tampons, will 
facilitate a cure. 
Allowing for prejudice, clumsiness in adjusting pessaries, 
and lack of judgment in the selection of proper instruments, 
a great deal of the opposition to these invaluable aids is due 
to not recognizing the presence or absence of mollities of the 
middle segment of the uterus. The writer has seen anteflex- 
ions of marked degree, in which this condition was present, 
relieved entirely by attention to hygiene, without any local 
treatment. Pessaries used in this class of cases often bene- 
fit, without any manual interference. But, if the uterine 
tissue has become hardened, the continual pressure of an 
unyielding, sensitive, engorged body upon a rigid instru- 
ment will give rise to great discomfort, and sometimes posi- 
tive injury. In like manner, repositors, used when mollities 
of the middle segment is present, are valuable ; whereas, if 
the uterus has been so long flexed that the atony has disap- 
peared, the greatest skill is required to effect the desired 
result, and hence many regard the repositor as a dangerous 
instrument. Again, digital reposition has often been aban- 
doned and set at naught because the practitioner has failed 
in reducing a rigid flexion after a few trials. If he recog- 
nizes mollities he can predict success by reposition. If it MOLLITIES UTERI. 
7 
is absent, he knows that he has a difficult case to deal with, 
and can make a guarded prognosis and expect long-con- 
tinued treatment before the case can be cured. 
Uterine massage will be found easy and of very great 
service if mollities is present. 
In conclusion, I would urge the members of this society 
to observe for themselves the several points raised. Careful 
study will probably confirm what has been said as to the 
presence of such a condition as mollities; its importance 
as a pathological factor, especially when the middle seg- 
ment of the uterus is affected ; and the value of recogniz- 
ing the condition with reference to prognosis and treat- 
ment in certain kinds of uterine disease. REASON'S WIIT 
Physicians sltonld. Sutailic 
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