A treatise on the diseases and special hygiène of females / By Colombat de l'Isère. Translated from the French, with additions, by Charles D. Meigs.
- Marc Colombat de L'Isère
- Date:
- 1850
Licence: Public Domain Mark
Credit: A treatise on the diseases and special hygiène of females / By Colombat de l'Isère. Translated from the French, with additions, by Charles D. Meigs. Source: Wellcome Collection.
Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
134/764 (page 128)
![except very rarely, in the strong, active, muscular subject, and that even in these subjects, the prolapsion is rather a state of immobility or fixedness of the womb at a low level, than a real prolapsus. I fully agree with M. Colombat in his general statement and rationale of the symptoms of our case, but I would call attention to the relations existing betwixt the sacral and hypogastric plexuses of nerves and the renal and solar plexuses, and indeed as extending to the whole splanchnic system, for an ex- planation of the extraordinary and complicated sympathies that are awakened in prolapsion of the uterus. M. Colombat has pointed out, as one of the complications of prolapsus, the induction of intense peritonitis. I have never met with such a complication in a long-continued and very extensive range of practice; but I have met with many cases simulating peritonitis so closely as to render the diagnosis very difficult indeed. I refer to the cases described in the Philad. Pract., at p. 141, and seq. The same kind of observations have been made by W. Maunsell, in his Dublin Practice of Midwifery, and, so far as 1 know, by no other authors. I shall reserve for a future page the ob- servations I have to make on the treatment of prolapsus uteri.—M.] As the phenomena that attend falling of the womb in the second degree are not always the same, and vary according as the distension of the uterine ligaments and the pressure of the womb upon the bladder and rectum are greater or less, we shall point out the symptoms most commonly met with. The patient cannot, without difficulty, continue either standing or sitting, and finds comfort only in the horizontal position. She feels pain in the groins, the loins, and the hypogastric region, with a sense of weight about the fundament, the perineum and vulva ; and, lastly, she has a distinct sense of the presence of a large tumour, which, upon the slightest effort, seems as if it would escape at the vulva. Like women in labour, she is liable to inappetency, nausea, and even vomiting, which all proceed from the sympathetic connection of the stomach with the womb. To these symptoms must be added those of constipation, of dysuria, and even of ischuria, arising from the pressure of the tumour upon the bladder and rectum, a pressure that is greater and greater as the tumour descends lower and lower into the vagina. The irritation of the womb, produced by this unnatural situation, and probably, also, the obstruction thence arising as to its circulation, often determine an attack of inflammation, accompanied by intense redness, and greater or less swelling of the uterus. Incomplete descent of the womb frequently presents to the medical attendant a degree of obscurity that it is quite impossible to dissipate, except by means of the Touch, properly performed, and in the man- ner to be described. In the first place, the woman must be examined in a standing posture, because the prolapsion is then greater than it is in the horizontal position, in which it may even wholly disappear. If the patient is a late riser, the operation should be deferred for several hours, and then it should not be done until after the bowels as well as the bladder, have been evacuated, for the womb is always,](https://iiif.wellcomecollection.org/image/b21029313_0134.jp2/full/800%2C/0/default.jpg)
