This is the most rare, the most formidable and dangerous form of uterine displacement. It occurs principally as an accident in connection with delivery. As in sudden and unexpected descent of the foetus through an unusually large pelvis, when the patient is walking or at the water-closet; or from too violently drawing upon the cord, the fundus of the womb has been known to be inverted and brought down with the placenta. This accident and complication of labor, will be referred to in its proper place in connection with delivery. Inversion of the uterus is here described, because although very unusual in the unimpregnated state, it may occur in consequence of the presence of polypus of the womb.
Inversion of the womb is analogous in its appearances to simple prolapsus of the entire circumference of the vagina. In either case the change begins above and consists in the inversion and depression of the affected part. In the womb, the fundus is at first simply depressed; and in this first stage the inversion is comparatively slight, and may be difficult or incapable of detection. But as the change increases, the fundus sinks down more and more within the body of the womb; and in this second stage, the inner surface of the fundus may be felt and recognized as a tumor, by introducing the finger within the os uteri. In the complete form of inversion, the womb entirely turned inside out, may be protruded without the vulva. In this case the mucous lining membrane of the uterus in its natural position, becomes its external covering. Thus, as in the case of prolapsus of the vagina, there are three different degrees of the inversion of the uterus, which may be designated as simple depression of the fundus; partial inversion, in which however the tumor formed by the inverted fundus does not reach the os uteri; and complete inversion, in which the womb is entirely turned inside out and protruded externally, constituting at the same time complete inversion and entire procidentia. This is a very serious complication of all the uterine organs; for the vagina must be more or less compromised and the Fallopian tubes, ovaries and bladder drawn down from their proper positions. Here not only the actual displacement of the womb and its appendages forms a serious difficulty, but the mere dragging upon those appendages forms a serious difficulty, but the mere dragging upon those appendages on the part of the womb, must also cause great distress and derangement in the organs themselves, and profound depression of the nervous system and vital strength.
The presence of a polypus in the inverted womb, may render the diagnosis comparatively easy. But it must be borne in mind that the inversion itself is due not so much to the actual weight of the polypoid tumor, as to its morbid influence upon the womb, and to the efforts which the womb makes to free itself by expelling the foreign body. Complete cases of inversion in connection with polypi, constitute a very grave form of disease; partly from the occurrence of haemorrhages and from the severe functional and constitutional derangements to which this condition may give rise; and partly from the unhealthy nature of the cause itself. For even if the polypus be not considered a malignant growth, it takes its rise in some depraved state of the system, and may be the index of more serious forms of disease, yet to be developed from the original dyscrasia.
Treatment The inverted womb should be carefully reduced and the whole organ replaced in the pelvis, with as little and as gentle manipulation as possible. The patient should remain in bed in such position as is found most comfortable; receiving such medicines as are best suited to the entire group of symptoms SENSATIONAL, functional and structural. So profound is the relation of the law of the similars to the human constitution, that even comparatively unimportant sensational symptoms, which, however, are peculiar to and characteristic of the case, may lead directly to the true Homoeopathic remedy for the entire disease. This simple fact, the stone which the allopathic and the chemical builders and even those of the so-called physiological school have rejected, bids fair to become the head of the corner in Homoeopathic therapeia. And this profound principle, confirmed by the constant experience of many careful observers and experienced physicians, should encourage the young physician to rely upon his Materia Medica, and not to despair even in the presence of serious functional derangements and even structural changes, for which he can see no direct and sufficient Homoeopathic analogue. In many forms of disease the sensational symptoms, which occur first, are intended as warning voices, fore-runners of the evil to come; and even in the more advanced stages of disease these sensations are still the most unfailing key-notes to the real remedies in the case, indices to the remedies not for the severe sufferings alone, but for the functional and even structural disorders which cause them and which they represent!
Select the remedy in accordance with all the symptoms present, with reference also to the constitutional history of the patient.
ANTEVERSION OF THE UTERUS is a displacement comparatively rare in the unimpregnated uterus. Anteflexion implies an inclination forwards of the fundus uteri, which though more than is natural, is still much less than actual anteversion. The fundus of the uterus, in anteversion is not only thrown forward, but actually impinges against the bladder and upon the pubis; the os and cervix at the same time are directed towards the sacrum. In this position the uterus lies directly across the pelvic cavity. In the most complete forms of anteversion, the uterus is bent upon itself at the inferior angle, the cervix retaining its usual position; this is anteversion with flexion.
Symptoms This form of displacement may come on gradually; and in this case it can be distinguished from simple prolapse, only by the touch. Where this affection suddenly makes its appearance, the symptoms may very nearly resemble those of falling of the
Page No. 111 Diagram of Anteversion and Anteversion with Flexion.
Page No. 112 Diagram of Partial Retroversion and Retroversion.
womb; the irritation of the urethra, dysuria and other disturbances of the urinary apparatus are usually more strongly marked.
Causes Anteversion of the uterus may result from the not very common hypertrophy of its anterior wall; from tumors or other pelvic growths. But the most frequent causes of this displacement are purely accidental and the result of violence, or muscular effort. The enormous accumulation of feces may sometimes operate as a displacing influence, and the combination of other causes may then easily serve to throw the fundus of the womb still further down in the pelvis, or even to press it beneath the symphysis pubis.
In the treatment of this form of displacement, desire the patient to remain quiet, or even, in severe cases, to keep her bed and lie on her back a few days, administer the remedy best indicated by all the symptoms, and a complete cure may be looked for in a very short time.
In those cases only in which the fundus is actually thrown beneath the arch of the pubis, will there be any necessity for any manual interference to remedy and cure this displacement.
And also observe that the female suffering with this form of displacement, should not urinate too often; since by moderately distending the bladder, it will assist in replacing the womb. And when in the recumbent position she should lie upon her back as much as possible, since this position will also aid the replacement. The general health being restored by the proper internal remedy, there will be no more trouble with the anteversion.
In OBLIQUITY OF THE UTERUS, either to the right side or to the left, study the remedies mentioned at the close of this chapter, in order to learn which one best covers the attendant symptoms.
As an auxiliary to the treatment, the patient should be instructed to lie as much as possible upon the side opposite to that of the obliquity, and to keep as quiet as possible.
RETROVERSION OF THE UTERUS is a form of displacement, which occurs next in frequency to that of prolapsus. The natural position of the uterus being with the fundus inclined over towards the bladder and symphysis pubis, in retroversion it assumes directly the opposite direction. This form of displacement is perhaps the most difficult of all; but no less important to ascertain and to remedy. By an exact internal examination by the touch, the fundus will be found turned back towards the sacrum, and even pressed down beneath its promontory, and the os uteri will be found turned towards the pubis.
Page No. 114 Partial Retroversion, with Flexion, Retroversion with Flexion.
As in simple prolapse of the uterus, so also in retroversion, there may be three different degrees or stages of displacement, according as the fundus is directed towards the upper, the middle or the lower portion of the sacrum. In all cases in which the womb has been so depressed backwards that its fundus is thrown down beneath the sacral promontory, this forms an insuperable barrier against its return, unless replaced by art. And the best method and the means of replacing it will be pointed out and described, together with the remedies which may be found useful in such cases.
