Symptoms The most strongly marked symptom indicative of retroversion of the uterus, is found in the inability to empty the bladder, which in greater or less degree is always present in complete cases of this displacement. Next to this is the pressure on the rectum, and consequent more or less frequent call to stool with great difficulty or impossibility of evacuating the bowel. These two complications, especially the retention of urine, render cases of complete retroversion of the womb dangerous as well as painfully distressing. While the retention and consequent accumulation of feces, serves to make the restoration of the uterus to its natural position a work of much greater difficulty. Nausea and vomiting, even stercoraceous vomiting, may set in and unless the patient is promptly relieved, she may sink under the accumulation of her sufferings.
Unlike anteversion, retroversion is more apt to occur during pregnancy; but we discuss it here, in connection with the other forms of disease which may appear in the unimpregnated uterus.
Causes The fundus of the uterus being loaded as it were in pregnancy, will readily tend to sink down either anteriorly or posteriorly, more and more, when from any reason it has been turned from its natural position. As occurring most frequently in early pregnancy, the chief cause of retroversion must be an unduly distended bladder, which may gradually raise the fundus of the womb from its natural inclination forwards, and cause it to assume more nearly a perpendicular position; then the still further increase in the size of the bladder from accumulation of urine, or some slight muscular exertion as in coughing, or any mechanical violence or pressure, may suffice to throw the fundus of the womb still further backwards and downwards, till it is fast secured beneath the promontory of the sacrum. This result may come on suddenly and be immediately made known by very serious and painful and even alarming consequences. Or it may be much more gradual in its onset, and for a while unsuspected in its nature. It is evident from the consideration of the inclination forward of the fundus of the womb in its natural position, that it can be made to assume such an inclination as to render it possible for it to be thrown backwards and downwards, only by some mechanical influences, and by such mechanical method it must be replaced; and the more especially since the sacral promontory presents such decided structural hindrances towards its restoration.
The Uterine Elevator, for Retroversion- This instrument, of which an accurate representation is given below, is composed of an ivory ball, a steel rod and an ebony handle. The diameter of the ball is about five-eighths of an inch; the rod, seven inches in length, and curved as in the cut, is firmly inserted into the ball at one extremity, and into the handle at the other. Originally designed by the writer and constructed for him, for use in retroflexion or retroversion of the uterus, this little instrument has been found capable of affording very valuable assistance in such cases.
The very unsatisfactory manner in which these displacements have generally been managed by physicians, has led the writer to adopt a new and very simple method of treatment, and to offer it to the profession in all such cases, when an operation or mechanical interference is necessary. And for the following reasons:
1st. It is less painful and less disagreeable to the patient.
2nd. It always insures a more perfect replacement of the organ, which, consequently, is less liable to relapse.
3rd. This plan will be found successful, when all others adopted by skilful and experienced physicians have failed.
4th. This plan will succeed in cases in which it has hitherto been deemed necessary to produce abortion, in order to replace the retroverted uterus. In these identical cases replacement is readily effected by this method, and pregnancy continues until the full term of gestation.
As soon as a case of this form of displacement is clearly diagnosed, if the urine or feces are retained, the usual means should be at once adopted for their evacuation. The patient should then be placed on the bed, neat its edge, upon her knees and elbows, so that the force of gravity may assist in the reduction. The ball of the instrument, well lubricated, is to be brought to the anus, with the convex surface of the rod upwards, then gently pressed till within the sphincter; when the handle should be slightly elevated, so as to bring the ball against the anterior wall of the rectum. The instrument is now to be firmly and carefully pressed up the rectum, when the ball will elevate the fundus, care being taken to raise the handle of the instrument more and more as progress up the rectum is made; and presently the uterus will again its normal position immediately posterior to the symphysis pubis.
In cases of long standing.- and the writer has recently replaced one of fifteen, and another of thirty years’ continuance, the reduction is not so quickly or so easily effected. The ball, engaging and partially elevating the fundus, will slip over and pass above it. The instrument must then be sufficiently withdrawn to engage it again; and, if necessary, the operation should be repeated, until the work is proved to have been entirely completed by the instrument’s meeting no obstruction as it is pressed with some degrees of firmness against the anterior wall and so passed up the rectum.
After the reduction is effected, the patient should be kept in a recumbent position, for a longer or shorter time-from two to twelve days, according to the more or less recent nature of the case; that the womb may becomes accustomed to its position: such remedies being administered in the mean time as may be indicated. The principal of these are Nux vomica, Belladonna, Sepia, Sulphur, Calcarea carb., Lycopodium, Calcarea phos., Kali carb. We give, for each of these medicines, the principal indications; each symptom being a key-note, which may be found a reliable guide. These, and other remedies which may be indicated in particular complications of retroversion, may be found at the latter part of this chapter, arranged in alphabetical order, under the general head of Uterine Displacements.
THE MEDICAL TREATMENT OF THESE VARIOUS FORM S OF UTERINE DISPLACEMENT, will depend in a great measure upon the selection of remedies according to their principal characteristics and to the corresponding characteristics and constitutional symptoms of the individual cases. For this reason we have combined in one schema the principal remedies for all the various displacements; believing that each variety and case of this disease will thus lead to its own appropriate remedy. The uterus is held in its proper position in the centre of the cavity of the lesser pelvis, and in a line with the axis of the superior strait, simply the round ligaments and a double fold of the peritoneum. When in a healthy state, the round ligaments hinder its retroversion. While the peritoneum, which covers its superior three-fourths anteriorly and its entire posterior surface, serves principally to prevent it from sinking down into the vagina, and at the same time assists also in preventing retroversion. Thus it is very plain that the womb cannot become displaced so long as the peritoneum and round ligaments are in a normal condition. And these ligaments can only lose their normal condition in connection with other disorders of the general system. Hence the remedies below, or others which may be called for in special cases, as they are indicated, by restoring the normal conditional of these appendages, will cure all uterine displacements, when no mechanical obstruction, such as is necessarily present in complete prolapsus or complete retroversion, intervenes. These appendages are usually relaxed in consequence of some constitutional ailments, which are shadowed forth by the symptoms indicating the proper remedy. The right interpretation of these symptoms, and the consequent administration of the corresponding remedy, will usually be followed therefore by a radical cure.
The practice of applying pessaries, or uterine supporters of any kind, is one which belongs to the principles of Allopathy, and is rapidly becoming obsolete. A few years more, and all these barbarous appliances, as useless and degrading as they are disgusting to the female sex, will be finally laid upon the same mouldy and musty shelves with the cups and the blisters, the leeches, the lancet and the actual cautery!
There is scarcely and remedy in the whole Materia Medica that may not be found useful in these displacements.
Aconite. If the prolapsus has occurred suddenly and there is in consequence great inflammation of the parts, with burning pain as if from hot coals; excessive sensibility to the least touch; bitter, bilious vomiting; anguish and cold perspiration, or hot and dry skin; fear of death.
Ammo. mur. A very characteristic symptom is discharge of a quantity of blood from the bowels at every catamenial period. During the catamenial the discharge is more profuse sat night.
