PROLAPSUS, INVERSION. ANTEVERSION. RETROVERSION.
AMONG the most common disorders of the generative organs and their appendages, are those which result in displacements of the uterus. These displacements, in all their different degrees and varieties, are included under the four heads of Prolapse, Inversion, Anteversion, and Retroversion of the womb.
We give in this place a brief description of these forms of displacement, with an account of the symptoms, causes and mode of treatment proper for each variety. And have arranged in alphabetical order at the close of the chapter, the remedies which are principally indicated in their medical treatment.
PROLAPSE, or SIMPLE FALLING OF THE WOMB, is by far the most frequent form of uterine displacement. This appears under three different degrees, to each, of which writers on this subject affix a particular name. Thus relaxation or descent of the womb, is understood to indicate the first and least form of displacement; and to consist only in a simple bearing down of the womb upon the upper portion of the vagina. In prolapsus uteri, the organ comes still lower down and may present at the orifice of the vagina. In procidentia uteri, there is actual protrusion of the organ; even the entire body of the womb being in some cases extruded from the vulva. These are all but different degrees of simple descent of the uterus in the line of the vagina. Although upon the examination of the same displaced organ at different times of the day, it may be found to be more or less prolapsed, according to the condition of active exercise or quiet, in which the parts may have been for some hours previous.
Symptoms: The principal and primary symptomatic indications of the descent of the womb are, dragging and aching pains in the small of the back; pulling, and bearing down pains in the lower part of the abdomen; sensation as if something would issue from the vagina; pains all much worse from walking or other exercise; the pains are remarked to have come on immediately after some exertion
Diagram of Prolapsus and Prolapsus with Flexion.
of an unusual kind, and after some more than ordinary muscular effort; frequent calls to pass water, dysuria or even retention of the urine. In the more fully developed forms of prolapsus or procidentia, the history of the case, the attendant circumstances, and the external appearance of the os cervix and even of the entire body of the uterus itself, can hardly fail to render the diagnosis at once easy and certain. And if the falling of the womb is not so far developed as to give any such external signs, the severe aggravation from walking and from lifting, together with the relief experienced from lying down, render the case sufficiently clear.
The causes of prolapse of the womb may be regarded as of two kinds; the more immediate, in which are included direct relaxation of the proper supports of the uterus; and the more remote, in which are included the incidental or constitutional influences which result in such relaxation.
The peritoneum forms the great suspensory ligament or membrane common to the contents of the abdomen. This is the grand function of the peritoneum, to sustain in their proper places and in their proper relation to each other, the various organs which are grouped together above and to some extent within the pelvis. The peritoneum is the true uterine supporter; the other ligaments tending rather to steady the uterus in its upright or inclined position, than to prevent it from sinking down in the pelvic cavity. This membrane, as already described, is reflected from the bladder upon the womb, in such a manner as to sustain it in front from its anterior surface. And it is so reflected from the uterus upon the rectum posteriorly, as to sustain it in that direction from its posterior surface. (See Figure). Thus it is evident that the uterus can sink in the pelvis, only so far as it is permitted by the relaxation of the peritoneum, its grand suspensory ligament. And this relaxation may be due to undue pressure from above; to influences excited upon it from beneath; or to its own inherent weakness from disease.
Next to the peritoneum, the broad ligaments, which in fact are but processes of the peritoneum itself, are influential in supporting the womb. And they will necessarily sympathize therefore with any inherent or constitutional weakness of the parent membrane; and at the same time be subject to the same adverse influences from above and from below. So far as the bladder, the rectum and the muscular parts of the pelvis are engaged in supporting the womb, it is evident that such support is all derived through the medium of the peritoneum and broad ligaments, by which the womb is connected with them.
The inherent weakness of the peritoneum and broad ligaments, which seems one of the most prominent causes of falling of the womb, is usually such weakness only as corresponds to the debilitated tone of the rest of the system. And hence the slightest additional strain brought to bear upon the womb from above by exercise, or unusual exertion, once causing these supports to give way, their stretched and strained condition, continually borne upon more and more by the superincumbent organs, allows little opportunity for them to recover themselves. Consequently prolapsus uteri is rather apt to increase more and more, than to recover spontaneously.
Chronic leucorrhoea is set down by some authorities as one of the causes of prolapse of the womb. But this is hardly correct. For in many cases the leucorrhoeal discharge will appear only after the occurrence of more or less serious displacement of the womb. And in other cases of persons of lymphatic temperament, that is of psoric or scrofulous constitution, the debilitating influence leads at the same time to the leucorrhoeal discharge and to the uterine displacement. The same thing is true of constipation, which is recognized as an important and frequent cause of falling of the womb. The same constitutional influence that renders the bowels incapable of expelling the feces, renders the suspensory ligament and membranes incapable of retaining the womb in its proper position. And the violent action of purgatives; and still greater weakness of all the connecting parts, that invariably follows their use, still further aggravates the constipation and the uterine prolapse.
The pressure from above of the organs contained in the abdomen, is often considered to cause descent of the womb. But it is against just such pressure from above downwards, that the peritoneum is intended to sustain the uterus. And except perhaps in cases of great over-exertion, or undue violence, it is not thought that the peritoneum yields to such pressure, unless previously weakened by some morbid influence. This is especially seen in those cases of prolapse which appear in connection with ascites, or ovarian dropsy.
Thus it is that the great majority even of the worst and most fully developed forms of prolapsus uteri may be regarded as disorders properly amenable to Homoeopathic medication, rather than as mere local displacements to be remedied by mechanical appliances. The case of Mrs. O., which came under my care some years since, illustrates the principle here inculcated, and at the same time shows what can be accomplished by the use of Homoeopathic remedies. This lady had been subject to complete procidentia uteri for at least ten years. The organ would protrude entirely without the vulva; and neither pessaries, supporters nor perineal pads could prevent it from thus making its unwelcome appearance externally. I requested her to take her bed; carefully washed and replaced the uterus, and gave Conium. A frightful leucorrhoea set in; but in the course of a single week this disappeared; and with the help of Platina, the induration of the womb and prolapsus were completely cured. The organ came down no more; in fact she never has since had any trouble of the kind. She has borne three children since; and is a well woman at this day. The Conium and the Platina were all the medicines used in this case; and no bandages or mechanical applications whatever were employed in the treatment, or subsequently used.
The same principle holds true with reference also to the vagina. So far as the descent of the uterus may be fairly attributable to relaxation of its walls, this relaxation is itself an evidence of morbid weakness, requiring appropriate medication. And even in those cases in which the prolapse of the uterus may seem to be owing to an unusually large pelvis, the natural supporters of the uterus can by proper attention be rendered capable of performing these functions in a far better and more satisfactory manner, than we can do it for them by the aid of pessaries or supporters. In like manner all that large and important class of cases of prolapse, which come on after confinement, can be prevented by observing suitable directions, or cured by appropriate Homoeopathic medicines.
INVERSION OF THE UTERUS.
