334 
PATHOLOGY. 
( 3 . Retroverfa, retroverted womb : the uterus difplaced, 
the lower part becoming the upper. Moftly limited to a 
Hate of pregnancy. 
y. Inverfa, inverted womb: the uterus difplaced, and 
turned infide out. 
This complaint confifts, as the name imports, in an 
inverfion of the cavity of the uterus, fo that the fundus 
comes through the os uteri ; confequently that part 
which formerly was the infide of a cavity is converted 
into the outfide of a tumour, either contained in the va- 
ina or projecting from it. In the prefent improved 
ate of the art of midwifery, this difeafe is very feldom 
met with, becaufe it is generally a confequence of vio¬ 
lently pulling the funis for the purpofe of extracting the 
placenta. The weight of a large polypus has been faid to 
have inverted the womb; but this is a very rare cafe. 
As inverfion of the uterus is (ftriCtly fpeaking) to be 
confidered as one of the immediate confequences of de¬ 
livery, (fee Parturition;) no admifiion would have 
been given to it in this article, if it were not that it is 
occafionally met with in the chronical ftate attended by 
a mucous difcharge. It may be necefiary to remind the 
reader, that the removal of the placenta (if adherent), 
and the immediate replacement of the uterus, are to be 
effeCfed as foon as pofiible when this accident has occurred 
during labour. The fymptoms of the chronic lfate of 
inveriio uteri referable thofe of procidentia uteri; and, 
an examination beingmade, a tumouris found either in the 
vagina,or hangingoutof theexternalparts. Such atumour 
may be millaken forpolypus; but, in the latter difeafe, the 
os uteri encircles the neck of the tumour; in inverfion of 
the uterus, the os uteri forms a part of the tumour itfelf. 
Moreover, the inverted uterus is fenfible : polypi of the 
uterus, on the contrary, are void of feeling. The tu¬ 
mour may be miftaken for procidentia of the uterus ; but 
the difference may be detected by obferving that there is 
no opening at its lower part, and by its furface fecreting 
the catamenia at the regular periods. It is diftinguiflied 
from procidentia of the bladder by being much more re¬ 
filling, by its fize continuing always the fame, and by the 
impoflibility of finding the uterus behind it. Whilftthe 
inverted uterus remains in the vagina, the difcharge (ex¬ 
cepting at the period of menftruation) will be of a mu¬ 
cous kind ; but, if the uterus falls lower, fo as to pro¬ 
trude beyond the external parts, the expofure of that 
furface, which in a natural ftate lined the cavity, to air, 
as well as to occafional injuries, may induce inflammation 
and ulceration over a part or the whole of its furface ; and 
the mucous difcharge may be changed to one of a puru¬ 
lent kind, fo conliderable in quantity as to debilitate the 
conftitution, and to caufe all the common fymptoms of 
weaknefs. If there are any ulcerations upon the furface 
of the upper part of the tumour formed by the inverfion 
of the vagina, they will be circumfcribed, and rarely cover 
its whole furface. In a cafe where the uterus has been 
long inverted, and lies in the vagina (the latter cavity 
having undergone no change except from diftention), it 
will not be advifable to recommend any other remedy 
than the injeCtion of fome very mild aftringent fluid, three 
or four times a-day, into the vagina. Some rellraint will 
be thus placed upon the quantity of the difcharge, and 
the parts will be kept clean by it. There is an extreme 
degree of difeafe where the uterus (previoufly inverted) 
falls out of the body, drawing down with it the vagina, 
and where the woman is becoming every day more and 
more weak from the quantity of the difcharge. Cafes of 
this kind can receive very little benefit from external ap¬ 
plication, and indeed are only to be treated by palliative 
medicines, as.narcotics and anodyne applications, unlefs 
indeed the patient ftiould have palled the menllruating 
age ; in which cafe, feeing that her comfort is deftroyed 
by the difeafe, and that the profufenefs of the difcharge 
perhaps threatens'her with death from the debility which 
it produces, it may be advifable to recommend the per¬ 
formance of an operation, which has in many cafes been 
attended with fuccefs, even in aged perfons. This ope¬ 
ration is the removal of the inverted uterus itfelf. See 
Surgery. 
2. CEdoptofis vaginae: protrufion of the upper part of 
the vagina into the lower. This, like the defcent of the 
uterus, may, according to the degree of the difeafe, be 
relaxation, procidence, prolapfe, or complete inverfion. 
The moll common caufe of this difeafe is an habitually 
collive ftate of the reClum, in confequence of falfe deli¬ 
cacy poltponing the period of natural evacuation. Thus 
the reClum acquires fo inordinate a capacity as to prefs in 
a very great meafure on the furrounding parts. As this 
preflure cannot difplace the bones of the facrum, its ef¬ 
fects are exerted on the part where there is leail refinance; 
viz. the back of the vagina ; and hence an aCtual pouch is 
formed at this part, which of courfe drives the membrane 
out of its natural fite. The falling-down of cylts of dif- 
eafed ovaries between the reClum and back of the vagina, 
operate in the fame manner in producing this difeafe. A 
tumour flightly external, a trifling degree of pain in the 
back, a flight diminution of the tumour when, the pa¬ 
tient lies down, with a difcharge of tranfparent mucus 
from the vagina, are the fymptoms of the malady. By 
the introduction of the finger in ano, the pouch above 
defcribed may alfo be felt. 
The treatment of the difeafe follows fo obvioufly, that 
little need be faid. To evacuate the reClum by fapona- 
ceous clyllers, or, if thefe do not fucceed (which isfome- 
times the cafe), by the introduction of the finger and a* 
fcoop in ano, is the firll thing to be done. The bowels 
mull be kept always open by mild cathartics, and a glo¬ 
bular pefl'ary introduced into the vagina, for the purpofe 
of fupporting the vagina and relloring the natural diame¬ 
ter of the reClum. Cold aftringents fliould be thrown 
into the vagina ; and cold bathing, efpecially of the loins, 
ufed externally. 
3. CEdoptofis veficae, protrufion of the bladder into 
the urethra. 
This difeafe, which has often been confounded with 
procidence of the uterus or the vagina, and confequently 
miftreated, confifts of a falling-down of that part of the 
bladder which lies pollerior to the entrance of the uri¬ 
nary palfage. In making this defcent, the bladder carries 
the vagina along with it, and, in very bad cafes, the an¬ 
terior lip of the cervix uteri; the latter indeed to fuch a 
degree, that the os uteri has been found to open direCtly 
backwards, and lying in contaCt with the pollerior part 
of the vagina. As in procidentia uteri, the bladder may 
defcend a little only from its natural fite, or it may form 
a large external tumour projecting from the labia. Pro¬ 
cidentia veficae is attended with a flight degree of pain, 
defcribed by the patient as a bearing-down. This is ag¬ 
gravated by the recumbent pofture: hence the patient 
is much afteCted with it during the night, at which time 
alfo flie experiences frequent calls to pafs her urine. A 
fenfe of tightnefs and pain is alfo referred to the navel; 
and both this pain and the bearing-down are increafed by 
fulnefs of the bladder and relieved by its emptinefs, 
though perhaps the latter is never complete ; for it feems 
that the prolapfed bladder lofes its contractile power, and 
hence that portion of this vifcera which forms the tu¬ 
mor generally contains fome water. A mucous difcharge, 
fometimes fmall and fometisnes very profufe, attends this 
difeafe. 
On examination with the finger, a tumor will be found 
in the vagina, diftinguiflied from procidentia uteri by the 
abfence of the mouth of the uterus, the anterior lip of. 
which, as we before faid, is often found ftretched down 
with the bladder. It is diftinguiflied from that and from 
all other difeafes of the parts in queftion, by the evident 
fluctuation of contained fluid, unlefs indeed we except 
encyfted tumours, which are diftinguiftiable however by 
their uniformity ; for, of courfe, thefe are not lefiened in„ 
fize by the expulfion of the contents of the bladder, as is 
the cafe in procidentia velicse. The difplacement of the 
4. bladder 
