Falling Over of the Womb.
Anteversion. The womb sometimes falls over forward upon the bladder, towards the pubes. This is called anteversion. The top is turned forward to the bladder; the mouth, back towards the large bowel. (Fig. 141, b.)
Retroversion. When the womb falls over backward, between the rectum and the vagina, it is said to be retroverted (d). This is just the opposite of being anteverted. In this displacement, the mouth is turned forward, the top backward.
This displacement may occur suddenly or gradually. If the former, there is generally great distress, and the organ should be immediately put back in its place; if the latter, the pain will be less intense, and the replacement must be effected by pessaries, particularly with the ring pessary, made of India rubber.
Anteflexion and Retroflexion. When these occur, the womb is doubled upon itself, the mouth of the organ not being tilted up before or behind, but retaining its natural position. These flexions are rep. resented by a, c, and e.
Besides these more common displacements of the womb, there are several slighter deviations which it is scarcely necessary to describe. There is the obliquity of the womb, which is simply a leaning of the organ backward or forward, or to one side.
There are still other more serious troubles, which are so very rare as not to require me to dwell upon them, such as the inversion of the womb, or turning it wrong side out, like the finger of a glove; and the hernia of the womb (hysterocele), which is like that of the bowel.
Pessaries. Much might be said about pessaries: they axe at times of the greatest assistance in keeping a badly placed uterus in its proper position ; on the other hand, they are serious hindrances to health. By their pressure they often cause inflammation of the ovaries and tubes and light up afresh old, quiescent chronic inflammations. They often stretch unduly the uterine ligaments and make a relaxed vagina. But it must be said that often, too, they keep in place a simply misplaced womb with no trouble and little expense to the wearer, thus avoiding long treatment and perhaps an operation. They should always fit accurately and nicely and should never cause pain or make the wearer conscious that she wears such a thing. The soft rubber variety, or at least those made of wire and covered with rubber, are the least likely to cause trouble; but they need, on the other hand, more frequent inspection and cleansing. The hard rubber are more easily kept clean, but are more dangerous. Whenever a pessary is worn, it should be under the surveillance of the family doctor, lest ulceration of the vagina and undue pressure on the internal parts ensue. Pessaries no doubt are very useful in keeping in place a womb that has been replaced and in warding off an operation otherwise indicated. They are of all shapes and designs, so that a description of them seems superfluous here.
Displacements. The various displacements of the womb are such common occurrences among womankind that they have always received considerable attention by the gynecologist. They result from falls in young girls, from enlargement of the organ, from weak uterine supports and poor health, from torn muscles of the vagina during labor, and from new growths in the womb.
The symptoms of a misplaced womb are from nothing to an amazing amount of trouble. Many a woman goes through life with a badly torn vaginal floor and retroflexed womb without the slightest ill effect, while her neighbor suffer intensely from a much low degree of displacement.
Operative Treatment. When for any reason a pessary cannot or ought not to be worn, and there is much inconvenience from the misplacement, resort must be had to packing the vagina and reducing the size of the womb, and allaying inflammation and pain before again trying a pessary, or else some of the several operations must be performed. Of these latter there are at the present day three principal methods in vogue, viz.:
Alexander's operation consists in cutting down on the little holes in. the lower abdomen, near the pubic bones, called the hernial rings, through which in the male the cord and vessels of the testes run, where hernia or rupture occurs, and through which in the female the the round ligament of the womb runs. This ligament is a small round cord attached to the anterior and top part of the uterus, acting as a stay. This ligament is dissected out and pulled up taut on either side (there are two, one on each side of the womb) till the womb is brought up into its normal position and there fastened. This operation is a very ingenious one, and answers well in simple uncomplicated cases.
Ventral Fixation is a second method of fastening the womb in place, and consists in opening the abdomen, lifting up the womb and fastening it to the under side of the abdominal wall. This method is tolerably free from danger, like the preceding, but has the advantage of parting adhesions which may bind down the uterus and prevent its rising, and of permitting the operator to see and correct any existing disease of the tubes and ovaries which so commonly accompany bad cases.
Vaginal Fixation is a third method, whereby the uterus is likewise fixed, but this time to the vagina in front of the bladder. This last method is at present receiving considerable attention; but it may be said that no one method is the best for all cases, the surgeon being the best judge of the situation. These operations are safe and efficient, and forever do away with pessaries and the existing disease. Women go on to term in labor quite generally after these operations.
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