PROLAPSUS UTERI—known also as PROC1DENTIA or DESCENSUS UTERI, by writers on the diseases of women; and as "falling down of the womb," or "hearing down," among non-professional persons—consists essentially in a depression of the womb below the natural level in the pelvis. It is a common affection amongst all ranks, and is most frequent in women beyond the middle age who have borne large families. It has, how ever, been met with in women who have not borne children, in virgins, and even (although very rarely) in children. It may occur in every degree, from the case in which the mouth of the womb is a little lower than its natural level, to that in which the womb itself pro jects externally, and forms a protruding tumor as large as a melon. In the latter case, it displaces by its traction the bladder, rectum, and other important structures. The pro lapse is termed imperfect as long as there is no external protrusion, and perfect when the womb is protruded externally. The causes of these different degrees of prolapse are the same, and the symptoms differ only in intensity. The immediate causes are, according to sir C. Clarke: (1) Relaxation of the ligaments of the uterus; (2), a want of due tone in the canal leading from the uterus to the external surface. The latter is probably the chief cause. After many child-bearings, it remains dilated, and its walls lose their resisting power. Similar effects result from repeated uterine hemorrhage, leticorrlaca (popularly known as the whites), and general debility. Under these condittons a very slight downward force will depress the womb; and thfs force is supplied by the increased. weight of the organ itself, if the patient sit up or walk soon after delivery, by violent vomiting or straining (when the bowels are constipated), by the endeavor to lift heavy weights, etc.
The symptoms arise partly from the pressure of the womb on other organs, partly from the simultaneous displacement of adjacent parts (as the bladder, rectum, etc.), and partly from reflex action (see NERVOUS SYSTEM). Patients with only a slight displace ment usually comMaiu of a sensation of fullness in the pelvis, of weight and bearing down, of dragging from the loins, often amounting to pain in the back, these symptoms being aggravated when the upright position is assumed. Strangury (q.v.) is occasionally
present, and if the womb descend low or protrude, there is always more or less diffi culty in evacuating the contents of the bladder and rectum. the digestive organs soon become affected through reflected nervous influence. It is a remarkable fact that the general health is often much worse in those cases in which there is a slight. depression than in those in which the prolapse is complete, and the womb forms an external tumor.
The treatment varies with the degree of displacement. In the milder cases, medicine should be administered with the ;dew of giving tone to the mucous membrane of the relaxed canal; while in the severe cases, mechanical support is requisite. In compara tively mild cases, prolonged rest in the horizontal position should be enforced, and cold water (front half a pint to a pint) should be slowly injected, night and morning, into the canal leading to the uterus, by means of an elastic bottle, the patient being in the recum bent position as she receives the injection. If this treatment is insufficient, astringent injections, as decoction of oak-bark or of galls, or a solution of alum (an ounce to the pint of water), should be tried. If, however, there is any congestion or inflammation of the parts, astringents must be avoided. In a case of complete prolapse, the first duty of i the practitioner is to attempt to restore the womb to its natural position. It is some times necessary to place the patient in a warm bath, or to apply fomentations or leeches to the tumor before it can be replaced; and occasionally, irreducible cases occur, in which it may be necessary to remove the organ altogether. But suppose it returned to its position, a repetition of the prolapse has to be prevented. The ordinary method is by the introduction of a pessary—an instrument of an oval or gloNlar form, and usually made of box-wood, which mechanically supports the uterus in its normal position. See the works of Churchill, West, and others On the Diseases of Women. In some cases a compress and bandage will afford sufficient support; while in other cases a surgical operation similar to that which is performed for prolapsus ani (q.v.) is expedient.