PROLAPSUS UTERI. 29 



bougies, and by anointing the cervix with anodyne unguents, 

 especially the unguent, aconiti. The second indication, by rest, exer- 

 cise in a recumbent posture, or, if it suits best, on foot or horseback, 

 tonics, nutritious food, cold bath, or the douche, and cheerful society. 

 Scarifications to the neck of the uterus are highly recommended by 

 Dr. Ashwell, especially if there be any congestion. The introduc- 

 tion of the pessary is often followed by marked relief, especially if 

 there be any descent. 



PROLAPSUS UTERI, 



Signifies a sinking of the uterus nearly or quite down to the os 

 externum ; when it protrudes beyond the vulva it is called prociden- 

 tia^ uteri. The position of the uterus has been already described. 

 (Page 22.) 



Causes. — Heaviness of the uterus itself; hence it often occurs in 

 early pregnancy; congestion of the uterus; ovarian and other abdo- 

 minal tumours ; tympanitis ; distention of the colon ; relaxation of the 

 ligaments, and too early "getting up" after labour; tight lacing; 

 dancing, running, or any severe muscular exercise ; leucorrhcea and 

 other exhausting discharges, straining, coughing, &c. 



SymjJtoms. — In some cases there is, no suffering at all, or .merely 

 a sense of fulness. At others, there is pain in the back and groin, 

 extending down the thighs to the knees or toes. The patient suffers 

 great distress in standing or walking, and in voiding the urine and 

 fseces. Strangury is sometimes present from the extension of the 

 irritation to the bladder. Sometimes leucorrhcea is present, at others 

 monorrhagia. The stomach and bowels sympathise ; there is ano- 

 rexia, loss of tone in both stomach and bowels, constipation or 

 diarrhoea, and sometimes tympanitis. The patient often becomes 

 morose and irritable. In procidentia the patient often suffers no 

 other inconvenience than that arising from the external presence of 

 the organ, or its acrid discharges. 



Diagnosis. — In addition to the above symptoms, a per vaginam 

 examination reveals the nature of the disease. The presence of the 

 OS uteri, at the lower part of the tumour, felt in the vagina, is almost 

 infallible. From prolapsus of the bladder, rectum, or vagina, it may 

 be distinguished by their greater softness and elasticity, and by the 

 absence of the os uteri. Procidentia may be distinguished from 

 partial inversion, by the presence of the os uteri at the lower portion 

 of the tumour ; by the absence of severe floodings, and by the smooth 

 surface of the tumour. 



Treatment. — Opinions differ much on this point. Nearly all 



agree as to the necessity of mechanical support in most cases. The 



difl[iculty is, as to the mode. In slight cases, rest in a horizontal 



position, with cold or astringent injections are often sufficient. In 



3* 



