PATHOLOGY. 
332 
a fymptom which often continues a long time without any 
other. In more advanced dages, this pain is defcribed 
as of a hearing-down or dragging kind, afenfation as of a 
weight dropping into the top of the vagina ; pain in the 
groins extending towards the labia is alfo felt, with a 
tranfparent vaginal difcharge, and a fenfation of fulnefs in 
all the parts of generation. Strangury likewife is occafion- 
ally prefent; and a reparation of the bones of the pelvis 
lias been met with by Mr. Clarke in one cafe. The fym- 
patliy between the uterus and domach alfo gives rile to 
much abdominal irritation. Anorexia, borborygmus, low- 
nefs of 1 'pirits, and languor, are very remarkable. The 
bowels are irregular in their aCiion ; and this date of dif- 
order, re-aCting on the uterine fecernents, fo far impairs 
their powers, that they admit red blood, and hemorrhage 
fometimes takes place. Hiccough alfo fometimes attends 
this malady. 
As mod of the above-mentioned fymptcms may be 
fnnulated by other maladies, it is indifpeniably neceffary, 
when procidentia uteri is fufpe&ed, that we fliould make 
a manual examination. As the uterus goes up to its na¬ 
tural dtuation, in early cafes, when the patient lies down, 
it is obvious that the only podure in which we can place 
her, to gain any information from examination, is the 
ereCt one. We need fcarcely advert to the delicacy of 
touch which even in thefe circurndances will be required 
on the part of the practitioner; a taCtus eruditus only to 
be learnt, however, by very accurate information con¬ 
cerning the druCture of the parts, and dill more by mid¬ 
wifery practice. When the cervix uteri has fallen down 
as low as the external labia, it often reds on the perine¬ 
um, and the difeafe remains dationary. In making this 
defcent however, and dill more as the uterus begins to 
form an external tumour, the dragging of this organ on 
the peritoneum exerts a very injurious induence on the 
abdominal vifcera; and from the fame caufe chronic and 
fometimes acute inflammation, ending in adhefion, has 
been known to attend this difeafe. 
Befides impairing the functions, it alfo very materially 
alters the druCture, of the inteflines and of the bladder: 
the reCtum, indead of taking the fweep of the facrum, 
fird dips down into the tumour, and afterwards afcends 
into the pelvis; the fallopian tubes and ovaria are dragged 
down with the uterus, as are alfo the fmall intedines and 
omentum ; the former of which fill up part of the tu¬ 
mour when it becomes external to the body. Under the 
fame circurndances, the bladder, falling into the tumour, 
drags down the meatus urinarius, and fo far alters the 
direction of this paflage, that, in order to introduce a 
catheter, it will be neceffary to hold the indrurnent almod 
horizontally. Months and even years often elapfe whild 
the uterus is making its defcent. While the procidentia 
is internal, a very profufe mucous difcharge fometimes 
conies from the vagina. When this happens, the patient 
luffers great debility. When, however, the uterus has 
fallen out of the body, the mucous membrane of the 
vagina lofes its fecreting difpofition, and from expofure 
to air, and from the dretching it differs from the tumour, 
takes on the appearance of external fkin, lofes its rugte 
and its nervous irritability, fenfible indeed to preffure, 
but not to fexual defire. After a time, the prolapfed part, 
efpecially the cervix uteri, becomes affeCted with fpots or 
patches of ulceration. Thefe, however, are not deep, 
and feldom of an unhealthy character: they readily heal 
on the replacement of the tumour in its natural fitua- 
tion. 
Other tumours are met with in the fame Situation as 
prolapfus uteri; but the latter difeafe is didinguifhed 
from all others by the horizontal opening of the cervix 
uteri; a mark which, contraded with the ■perpendicular 
opening of the urethra in the male fubjeCt, has ferved to 
detect the impodure of thofe who, having a prolapfus 
uteri unufually oblong, have endeavoured to impofe on 
credulity by the affumption of an hermaphrodite forma¬ 
tion. 
In the treatment of this difeafe, we have two indica¬ 
tions to perforin. The fird is, to get the uterus back 
into its natural fituation; and thefecond to keep it there. 
In early cafes, the fird indication is effected by merely 
putting the patient in a recumbent podtion, this being 
attended with a remidion of all painful fymptoms. In 
the early dages of this difeafe, all therefore that will be 
neceffary for the fird indication will be to keep the pa¬ 
tient generally lying on a mattrefs (in the day-time on 
a fofa), and obviating all mufcular movements likely to 
prefs on the uterus; as coughing or draining at doo!. 
The indications of drengther.ing the relaxed date of the 
vagina embrace a wider field. It is obvious to every one, 
that, if the mufcular fyltem be in a weak date generally, 
it is quite impofllble to render any one mufcle drong by 
local applications. Now, as it is the mufcular druCture 
of the vagina which we here wifh to operate upon, we 
mud attend to the date of the mufcular fydem through¬ 
out the body. The diet mud be regulated in fuch a man¬ 
ner as to have the mod perfect adimilation : warm drinks, 
as tea, &c. forbidden ; the bowels kept open by the 
rnilded laxatives, and the cold bath ufed regularly. We 
need not dwell upon the concomitant diforders which 
will prevent the ufe of the cold bath ; thefe having been 
fo often adverted to. We have before dated as a genera! 
rule, that this meafure is never to be perfided in unlefs 
followed by re-aCtion. A fhower-bath impregnated with 
fait is ufeful forperfons of good damina, when the Ample 
bath lofes fome of its influence. Medicines of the tonic 
kind, as improving the digedive powers of the domach, 
are alfo recommended; as bark, gentian, See. It is de- 
iirable to join with thefe, medicines which have a power 
of adringing the veffels of the mucous membranes. We 
are rather fceptical as to the control of any particular 
medicine over local diforders, except when applied direCt- 
ly to the druCture affeCted ; but it is dated on refpeCtable 
authority, that certain medicines taken into the domach 
do relieve relaxation of the vagina, a circumdance refer¬ 
able, of courfe, to the known fympathy which exids 
between the domach and the mucous expanfion in gene¬ 
ral. Cinchona and fulphuricacid is a formula much em¬ 
ployed. Inperfons much debilitated it will not be found 
late to ufe the cold bath fo frequently, or to give fuch 
powerful adringents as we have recommended above; 
but of courfe all rules of this kind mud vary with parti¬ 
cular circurndances. 
In early dages of procidentia, the fponging or dafiiing 
of cold fprmg or fait water on the loins and pudenda, 
and the injection of adringent lotions, are the local 
means to be chiefly relied on. The adringent applica¬ 
tions are to be applied to the interior of the vagina by 
means of a fyringe, to the condruCtion of which it be¬ 
hoves the practitioner to pay fome attention. The pew¬ 
ter indruments in common ufe are many of them next to 
ufelefs; it is indifpenfible that the pipe prefent a fuffi- 
cient curve to allow to life the indrurnent with eafe ; that 
the pidon is perfectly adapted to the barrel, and moves 
with celerity; and that the holes at the extremity of the 
pipe are fmall, and dtuated at the point, and not laterally. 
The adringents bed recommended are, a mixture of dilu¬ 
tions of alum and fulphate of zinc, or one or both of 
thefe falts difi'olved in a decoCtion of oak-bark. Thefe 
applications fliould be thrown up twice or three times 
a-day. 
When procidentia uteri is fo far advanced as to render 
the attempt at reduction by the above-mentioned mea- 
fures ufelefs, we mud endeavour to give mechanical fup- 
port to the difplaced uterus. For this purpofe an indru- 
ment called a pefj'dry is ufed. It is various in form and 
fubdance. The form mud vary with the dage or peculi¬ 
arity of the complaint. The mod proper fubdance at pre¬ 
fent ufed for the formation of a pedary is box-wood. The 
circular pedary is adapted to thofe cafes in which the dif¬ 
eafe has not made great progrefs, and where the relaxa¬ 
tion of the vagina is not confiderable. Its adaptation to 
the 
