) Churchill. These inter-pelvic tumors may not attack attention, until from their size they impede the free action of the rectum or the bladder; or render parturition difficult by occupying an important portion of the pelvic cavity. In some instances these tumors are of the nature of fungous or cancerous growths. But ordinarily the tumors of fibrous form, which appear in the vagina, and still more especially in the uterus, are attended with serious inflammation in the adjacent tissues. And the inflammatory disease which arises in connection with uterine fibrous tumors, or polypi, must be the great cause of the local and general painful symptoms and haemorrhages which arise in such cases. Thus in the Allopathic practice it has been discovered, by the hard experience of the ill-success which has so often attended the removal of these tumors of the vagina, and uterus, whether pendulous or still adherent, thaprotruding beyond the vulva.
DISPLACEMENTS. SPASMS AND CRAMPS. NEURALGIA.
PROLAPSUS OF THE VAGINA. Prolapsus of the Vagina is an affection resulting in general from a relaxed or weakened state of the vaginal parietes. It may easily be mistaken for prolapsus of the womb; but a careful attention to the history of the case and to the conditions present, will conclusively determine the matter. The may be wholly or partially prolapsed. Thus there are three forms of vaginal prolapsus, which require to be considered and distinguished. First, complete prolapse or inversion of the vaginal canal; second, prolapse of the anterior wall of the vagina; and third, prolapse of the posterior wall of the vagina. In connection with a brief notice of each of these three forms of vaginal displacement, we mention the most active producing causes; and mode of distinguishing each from the others.
I. Complete prolapse, or total inversion of the vagina, is, perhaps, the least common of these three forms, as it is also the worst, especially where the parietes are actually protruded. This form may appear in connection with parturition; as the result of weakness or looseness in the walls of the vagina; of too great size or too rapid descent of the foetal head; of mechanical interference, especially turning :–or it may come on gradually, from the combined influence of various similar causes especially in women who have borne many children.
It is important to understand clearly the nature of the change which takes place in this displacement,–and which is properly called inversion, although the term may fail to convey the full idea. Suppose a long stocking to be suspended with the anterior part of the foot upwards; now let a heavy weight be laid upon its apex (the toe of the stocking)–and allowed to sink down through the foot and leg of the stocking; this will cause an actual inversion; and by the time the inverted point of the apex has made its appearance at the open extremity of the leg, on e half of the stocking will have become inverted. In such a manner the vagina may be prolapsed and inverted where the entire circle of its canal is involved; although the circle of inversion may not begin at the apex of the vagina. The puckered orifice, composed of the folds of the mucous coat of the vagina, which appears in the centre of the projecting tumor, should be distinguished from the regularly formed os uteri,–which is narrower in structure and marked by a fissure which separates the anterior from the posterior lip. In these cases of complete inversion of the vagina, the finger pressed upon either side of the tumor will be arrested at the bottom of the cul-de sac, formed by the doubling of the wall of the vagina upon itself. In any event, the finger introduced into the orifice of the prolapsed vagina, may be made to reach the os uteri, above, and thus remove all possible ground of doubt, as to the exact nature of the case. This form of prolapse of the vagina is usually connected with some degree of corresponding displacement of the uterus. There is also an increased discharge of mucus, which is the result of the displacement itself and of its producing cause.
II. The prolapse of the anterior portion of the vagina, is usually connected with a similar displacement of the bladder. The same influences which weaken and relax the anterior portion of the vaginal parietes are exerted in a similar manner upon the attachments of the urinary bladder; and the undue accumulation of urine in the bladder, resulting from its too long-continued retention, suffices to cause the parts to yield still more to the constant and increasing pressure.
This form of displacement is evidenced by the sensation of weight in the vagina, followed by an actual fulness and intumescence or swelling in the front of the vagina just within the vulva. At the same time, there is a painful dragging sensation in the lower part of the abdomen, frequent and painful micturition,–in addition to the difficulty of passing water; it may sometimes be impossible to do so until the parts are in some measure replaced. On attempting to introduced the finger into the vagina immediately beneath the pubis, it reaches the bottom of a cul-de-sac; while, if the finger be introduced behind the protuberance, the os and cervix uteri can be found nearly in their natural position. These symptoms can hardly fail to determine the nature of the difficulty. The tumor formed by the anterior or vesical prolapse of the vagina, presents a round, elastic, fluctuating appearance at the orifice of the vagina; and may usually be much diminished in size by drawing off the urine with the catheter, where there is any considerable dysuria. And as the water again accumulates in the bladder, the vaginal tumor becomes at the same time larger and more painful. This last-mentioned circumstance alone, where it appears, will of course conclusively determine the nature of the difficulty.
The prolapse of the anterior parietes of the vagina, attended as it usually is by that of the bladder, may be distinguished from prolapsus uteri, by the fluctuating nature of the tumor, and by its broader shape at its apex,–that of the uterus being hard, firm and pointed. The passage of the finger into the vagina, behind to the tumor, will distinguish it from prolapsus of the posterior wall of the vagina.
This prolapse of the anterior portion of the vaginal walls, whether caused or merely accompanied by prolapse of the bladder, is sometimes called cystocele or hernia of the bladder.
III. Prolapse of the posterior wall of the vagina. In this form of vaginal displacement the rectum is usually involved, as the bladder is in the anterior form just described. In some rare instances both these forms of prolapse of the vagina appear in the same person and at the same time.
The sensations attending displacement of the posterior parietes of the vagina are similar to those which arise from that of the anterior wall; except that they are rather referable to the rectum and call to stool, than to the bladder and desire to pass water. And the tumor diminishes after the evacuation of the bowel.
The finger passed up anteriorly to the tumor will reach the os uteri,–and this circumstance will distinguish this difficulty from that involving the anterior wall of the vagina. While the tumor itself although compressible, has not the fluctuating sensation discernible in that caused by the descent of the urinary bladder. The relative position of the apex of this tumor, as well as its variable size and more yielding character, enable us to distinguish it from prolapse of the womb. And in addition, by introducing the finger in front of the tumor, the os uteri and cervix may be found in their natural position. In this as in the other forms of the vaginal prolapsus, the unusual exposure of the delicate mucous surfaces and their irritation from friction against the adjacent parts, cause leucorrhoea and more or less inflammation of the organs.
Arnica m. When it is the result of violent shock or concussion.
Mercurius. When the sufferings, such as pain, itching smarting, &c., are worse at night, all night.
Sepia. When burning with sharp-shooting pain is experienced in the affected parts. The sensations are worse while sitting quietly, particularly in the forenoon and evening. Sense of weight in the anus. She has to cross her thighs, as if to prevent the escape of the inner parts.
Stannum. Much inconvenience is felt during a hard stool. Great lassitude when walking. Great anguish and melancholy during the week previous to the menses; the distress of mind cases as soon as the menses begin to flow. Contusive pain in the region of the malar bone during the menses.
Refer to PROLAPSE OF THE UTERUS, for other remedies.
STRANGULATION of the prolapsed portion of the vagina, whether it involve either the bladder or the rectum within the stricture, is a complication worse than the original difficulty. As in cases of strangulated hernia, -which are similar, prolapsed and structured conditions of a portion of the intestine,-the obstruction of the bowel or of the bladder, may very suddenly give rise to most distressing and alarming symptoms. These are best relieved by remedies selected in accordance with the constitutional symptoms,-which, by removing as it were the spasmodic constriction of the parts, allay the inflammation, and enable the return of the circulation to take place in season to prevent mortification.
