DISEASES OF THE UTERUS. 



scent or prolapse of the uterus only exceptionally occurs in women 

 who have had no children. When they do occur, it is because the 

 same conditions exist as after confinement, and particularly because 

 the vagina is relaxed by blennorrhoea and venereal excesses, or the 

 uterus is pressed downward by heavy tumors in the pelvis. If 

 prolapse of the uterus take place suddenly, as occasionally happens 

 from lifting heavy weights, from severe coughing, or strong bear- 

 ing-down efforts, the stretching of the ligaments causes severe pain 

 in the abdomen, and great general disturbance, fainting, nausea, 

 etc. If the descent or prolapse develop slowly, there is usually but 

 little annoyance at first ; this consists chiefly in an undecided feel- 

 ing of pressure downward, and in stretching pain in the lower part 

 of the abdomen and small of the back. The deeper the uterus de- 

 scends, the more annoying these symptoms become ; they increase 

 when the patient stands up, walks, coughs, etc ; they diminish dur- 

 ing rest, and in the horizontal position. There are also inconven- 

 ience and pain during urination and defecation, and there are con- 

 stipation, colic, and other symptoms due to dislocation, pressure, 

 and tension of the abdominal organs. If the uterus project from 

 the vulva, it at first forms a round or oval tumor, as large as a wal- 

 nut, which may be easily replaced ; but soon the uterus covered by 

 the vagina advances, the tumor rapidly increases in size, and is re- 

 placed with difficulty ; it feels doughy, but on firm pressure we 

 may distinguish a hard body more deeply seated. If, with the 

 anterior wall of the vagina, the fundus and posterior wall of the 

 bladder be drawn through the vulva (cystocele), on the anterior 

 wall of the prolapse we may see a tense and sometimes fluctuating 

 tumor, which swells and subsides again several times during the 

 day, and into which, by exercising some skill, we may introduce a 

 male catheter through the urethra. On introducing the finger into 

 the rectum, we find it bulged forward. The os uteri gapes open, 

 because the vaginal portion is averted ; it is reddened and covered 

 with glairy mucus. The prolapsed vagina is dry, parchment-like, 

 thickened ; the epithelium resembles epidermis ; frequently it is ex- 

 coriated by the friction of the clothes and the irritation of the urine 

 that trickles over it, and not unfrequently deep ulcers form in it. 



The treatment of dislocations of the uterus is purely surgical ; 

 and it would lead us too far to speak even of the choice of certain 

 pessaries, and of the rules for their introduction and employment. 



