Diseases of women, including their pathology, causation, symptoms, diagnosis and treatment : a manual for students and practitioners / by Arthur W. Edis.

Edis, Arthur W. (Arthur Wellesley), 1840-1893.

Date:: 1881

Credit: Diseases of women, including their pathology, causation, symptoms, diagnosis and treatment : a manual for students and practitioners / by Arthur W. Edis. Source: Wellcome Collection.

69/566 (page 49)

$extensive and even fatal sloughing. Rupture or lacei'ation of the vagina may take place from forcible attempts to return the procident uterus. Occlusion of the cervical canal, after the menopause, has also been observed in some cases. Hydronephrosis, with dilatation of the ureters and enlargement of the bladder, may result from the displacement of the base of the i bladder. Sudden or acute Prolapsus Uteri may occur from any violent^ muscular efforts, even in nulliparae. It has been observed in cases of epilepsy, severe fits of coughing, forcible straining at stool, attempting to lift heavy weights, and other similar conditions. Where the uterus Is enlarged from subinvolution, or pregnancy in the early stage, or from the presence of fibroid tumours or polypus, or from hyperplasia, especially if the vagina be lax, and the uterine suppoits weakened from previous stretching, sudden prolapsus is still more liable to occur. The patient feels that something has given way within her. There is generally more or less shock, with severe pain over the abdomen, tenesmus, or bearing down, with iiritation of the bladder ~aiid'rectum. Peiitonitis is very apt to occur in consequence. Treatment. ^^\\v first effort will natuiully be to i-eplacethe uteiiis in its normal position, our next to keep it there. Methods of replacing the Uterus.—Where prolapsus exists only in the first or second degree, there is seldom much difliculty expe- rienced in accomplishing the reduction. Resorting to the semi-prone or genu-pectoral position, and allowing the air to gain access to the ^vagina, so as to gain the advantage of atmospheric pi'essui'e, will often be sufficient. Gentle, but steady pressvire upwards, by means of one or two fingers passed per vaginam may be resorted to if requisite. It is always well to secure a thorough evacuation of the bowel and also of the bladder beforehand. Where prolapsus of the third degree, or procidentia, exists, the pi'O-f I truding mass must first be well lubricated with oil. It is then grasped I ' firmly in the hand, compressing it, if necessary, for a short time, so as \ to reduce its bulk, and then pressed gently and steadily upwards in ] the direction fii'st of the pelvic outlet, then in that of the cavity,! endeavouring to return first the upper portion which was the last to J be prolapsed. If any difficulty be experienced, further efforts should be desisted from at present; the patient being kept at r est in bed for a day or fwb and enjoined to resort frequently to the genu-pectoral position; a'perineal bandage being employed to keep up gentle pressure, and cooling evaporating lotions being used, so as to lessen the congestion and reduce the bulk. Pressure by means of strapping or elastic bandages has been sug- gested, but it is seldom that it will be requisite to resort to this expedient. After a few days the mass will be found to have diminished con- siderably in bulk, and can then be readily returned. No excessive force should ever be attempted, as laceration or rupture of the vagina might occur and prove fatal. Where much difficulty is experienced in completing the reduction, it will generally$