VAGINA. 



of the vagina. But when the protvufion coniprelicwds only 

 a portion of one of the fides of this tube, the tumour occurs 

 in the form of a cul-de-fac, which can be put back into the 

 vagina with the finger or probe, and the lower end of 

 which is without any aperture. The following differ- 

 ences are alfo remarkable in cafes where the lining of the 

 vagina conftitutes the prolapfus. In fome inftances, the 

 lining of the whole circumference of the part protrudes in 

 the form of a cylindrical fwelling, confiiling of a duplicature 

 of that coat. In other examples, the membrane lining the 

 vao-ina is relaxed and elongated only at one or more par- 

 tic'ular points, and produces one or more external fwellings 

 of the cul-de-fac figure. This laft cafe is liable to be mif- 

 taken for polypi of the vagina. 



The poffibihty of a prolapfus of the whole of the vagina, 

 together with all its coats, has been doubted by Sabatier 

 and Levret ; but, as Richter conceives, without any real 

 foundation. If, as the latter author obferves, it is poffible 

 for the inner coat of the vagina to feparate from the exter- 

 nal, with which it is intimately connefted, an event which 

 every body admits as happening in the fecond kind of pro- 

 lapfus vagina;, why (hould it be impoflible for the whole of 

 this tube, together with all its coats, to be feparated from 

 the furrounding parts, to which it is not fo ciofely adherent ? 

 Sometimes the reftum, inclufive of all its coats, forms what is 

 termed a prolapfus atii, and why may not the vagina be dif- 

 placed in a fimilar manner, fince it muft be much more 

 liable than the reftum to be propelled downwards in the 

 violent Ilraining which takes place during parturition ? 

 Richter aflis, whether every prolapfus uteri is not accom- 

 jianied with fuch a difplacement of the vagina ? Cafes are 

 upon record, where the prolapfus of the vagina happened 

 all on a fudden, in confequence of falls, the ftarting of a 

 horfe, &c. (Hoin, Levret, Journal de Medecine, tom. xl. ) 

 Here it cannot be fuppofed, that the cafe was merely a pro- 

 trufion of the inner coat, which can only be gradually re- 

 laxed and elongated. Laftly, inftances in which the pro- 

 lapfus of the vagina was feveral inches in length, have been 

 gradually reduced by means of external preffure. (Hoin.) 

 How can we imagine, fays Richter, that fuch cafes could 

 proceed from any degree of relaxation, to which the mem- 

 branous lining of the vagina is liable ? 



It muft be acknowledged, however, that this fpecies of 

 prolapfus is much lefs common than the fecond kind ; that 

 when it occurs, it is generally as a confequence of a pro- 

 lapfus of the uterus ; and that it cannot eafily happen at 

 all, except about the time of delivery. A prolapfus of the 

 inner coat principally occurs in married women who have 

 had many children, and been frequently troubled with fluor 

 albus. It has, however, been occafionally met with in 

 young unmarried females. The prolapfus of one particular 

 portion of the inner coat of the vagina, is generally the con- 

 fequence of a hernia in this part ; but fometimes in cafes of 

 dropfy, a portion of the vagina, containing fluid, protrudes 

 in the form of a cyft, or fac. 



When the whole circumference of all the coats is involved 

 m the prolapfus, if a finger, or probe, be introduced into 

 the cyUndrical tumour, which' the vagina then forms, the os 

 uteri will be found to be fituated ciofely behind the external 

 pudenda; for this fort of bearing down is always attended 

 with a difplacement of the womb, in the direftion down- 

 wards. In many inftances, particularly when the prolapfus 

 has taken place fuddenly, and is quite recent, the patient 

 experiences a variety of complaints about the bladder and 

 reftum, and the evacuation of the urine and faeces becomes 

 more or lefs interrupted. That the protrufion compre- 

 hends all the coats of the vagina, is frequently quite raanifeft 



from the thicknefs of the cylinder. Alfo, when the acci - 

 dent has occurred fuddenly, or it can be eafily reduced, 

 there is always reafon to conclude that the prolapfus is of 

 the preceding defcription. 



The prolapfus of the inner membrane of the vagina gene- 

 rally arifes gradually, and often as a confequence of a long- 

 continued fluor albus. It either does not admit of reduc- 

 tion, or, if reduced, it lies in the vagina, and fills its cavity. 

 It has very little tStSi. upon the uterus itfelf, which ufually 

 remains in its natural pofition, and it feldom produces any 

 difficulty in the evacuation of the urine and fseces. When 

 only a part of one fide of the inner membrane of the vagina 

 is relaxed, elongated, and protruded, the fwelling can be 

 pufhed back into the vagina with the finger, and thus the 

 nature of the complaint becomes manifeil. The prolapfus, 

 arifing from a hernia in the vagina, can only be afcertained 

 by attending to the fymptoms which charafterife this fort 

 of rupture, and which are noticed in the article Hernia. 



A prolapfus of all the coats of the vagina, while it is 

 fmall and recent, can be reduced by preffure without diffi- 

 culty. But the thing which demands the greateft care, is 

 to hinder a relapfe. This is accompliflied by the employ- 

 ment of a pefiary, and the ufe of aftringent applications. 



When, however, the laft fpecies of prolapfus has exifted 

 a long while, its reduftion is more difficult ; for the vagina, 

 after it has remained difplaced a certain time, begins to be 

 affefted with fwelling and induration. According to the re- 

 ports of Hoin and Levret, a large protrufion of this kind, 

 ten inches in length, was fo diminifhed by keeping the pa- 

 tient 'invariably confined upon her back, that in the courfe 

 of a month the reft of the tumour admitted of being re- 

 duced. Indeed, as Richter obferves, there can be little 

 doubt, that the treatment which has been advifed by fome 

 authors for the diminution ot very old enormous omental 

 ruptures, would here be equally applicable ; ni'tz. long con- 

 finement in bed upon the back, with the buttocks fomewhat 

 elevated ; continued, vvell-direfted, external preffure ; a very 

 low diet, and repeated mercurial purges. By fuch means, 

 no doubt, the fwelling might be in many inftances fufB- 

 ciently leffened to admit of reduftion. 



During the ftate of pregnancy, a prolapfus of the fore- 

 going kind may be attended with confiderable embarrafl- 

 ment, and even danger. In one cafe, where iuch a prolapfus, 

 five inches in length, took place during labour, it became 

 neceffary to turn the child, and the difplaced vagina was alfo 

 lacerated. The woman, however, recovered. ^ Pietfch, Jour- 

 nal de Medecine, tom. xxxiv.) In another cafe, where the 

 prolapfus became as large as a man's head at every return of 

 the labour-pains, the praftitioner fucceeded in holdi.ig the 

 parts back, while the woman was dehvered with the aid of 

 the forceps. ( See Loder's Journal, i b. p. 490. ) When 

 this is imprafticable, it is neceffary, according to Richter, 

 to make an incifion through both fides of the prolapfus ; a 

 proceeding, fays he, to which the praftitioner may the more 

 readily make up his mind, inafmuch as the parts have even 

 been lacerated, without any ill confequences, as we have al- 

 ready related. 



The prolapfus of tlie inner membrane of the vagina, 

 while fmall and recent, may perhaps be removed by aftrin- 

 gent applications. When, however, it is of long ftanding, 

 indurated, and of large fize, much expedlation of fuccefs 

 from this treatment cannot be entertained. Richter fees no 

 reafon vvhy, in fuch a cafe, the redundant relaxed part 

 ftiould not be cut away, efpecially when the difeafe is accom- 

 panied with ulceration, and other ferious complaints. As 

 he obferves, there can be xio doubt that a prolapfus of the 

 inner membrane of the vagina, when limited to one part of 



this 



