From these remarks on the diseases of this important organ, we pass on to a very brief notice of its occasional misplacements. The singular mobility of the womb (with out which pregnancy would be almost an impossibility) exposes it to the risk of displace ment to such a degree as often to give rise to great personal discomfort. As all the causes which tend to produce displacement (such as increased weight of the organ dur ing pregnancy, pressure of the superincumbent viscera, etc.) act in a downward direc tion, the obvious tendency of the womb is'to be thrown downward, or to suffer prolcopsus (q.v.), an affection which, in its extreme degree, when the organ is more or less pro truded externally, is termed prociclentia. Causes sometimes come into play which incline the upper part of the uterus either backward or forward, giving rise to retroversion and anteversion, instead of mere prolapse. Prolapsus is sufficiently considered in the article bearing that title; and for a description of the symptoms and treatment of the two last nameemisplacements, we must refer our readers to the standard works on the diseases of women.
The tendency of the womb to hypertrophy has been noticed at the beginning of this article; its individual tissues have a similar tendency to overgrowth, showing itself at particular parts, and thus giving rise to tumors or outgrowths, which are more com mon in this than in ally other organ. Under this head may be mentioned several varie ties of polypus, which differ essentially in structure, but all of which are invested by the mucou smembrane which lines the uterus, and are liable to be the source of hem orrhage. Their surgical means is generally a matter of no difficulty. Much more important than these is the fibrous tumor; which is frequent in its ocurrence, seri ous in its effects, and very slightly amenable to treatment. These tumors are of a spher ical form and firm texture, resembling that of the womb itself, and usually occur in groups; several being frequently present, while one or two are considerably larger than the others. The symptoms to which they give rise vary extremely according as the chief tumor lies on the, outer part of the womb, and grows into the abdominal cavity, or is developed within the walls of the womb, or projects into the interior. They may be of almost any size, cases being ou record in which they weighed from 70 to 80 pounds. In regard to the symptoms of this affection, it must be premised that sometimes these tumors exist without exciting any disturbance, and that growths on the outer surface give rise to comparatively unimportant derangements, compared with those which are imbedded in the walls, or occupy the cavity of the womb. It will be readily understood
that women who have passed the change of life (as it is popularly called) suffer less from these tumors than younger women. The diagnosis of fibrous tumor .is effected partly by manual and instrumental examination (into which we shall not enter), and partly by the symptoms—such as (1) hemorrhage occurring in about 50 per cent of cases indepen dently of their nature; (2) disturbance of the menstrual discharge in 62 per cent of cases, it most commonly being excessive and often painful; (3) pain, usually constant, and occasionally only at the menstrual period, described by some patients as a burning sen sation, by others as a sense of bearing down, and by a few as occurring in paroxysms of intense agony; (4) dysuria—pain in voiding urine, or difficulty in discharging it, or fre quent desire to pass it. It is usually hemorrhage, or inability to void the urine, that first directs the attention of the patient to her malady. Its tendency to excite abortion often leads the physician to suspect its presence. Although, we previously men tioned, this is an affection little amenable to treatment, a woman with these symptoms should at once consult a physician (if possible, the physician-accoucheur to a large hos pital), who, by his advice as to the general management of the case, especially during the menstrual period, may do much to palliate her sufferings. Iodine, bromine (and cer tain mineral waters containing these elements), and mercury have been vaunted as specifics, but nothing positive can be said regarding their successful action; and certain surgical operations have been recommended, which are accompanied with so much danger to the patient that it is needless to refer to them. But although the action of medicines on these growths is avowedly uncertain, nature in this as in many other cases not unfrequently strives toward a more or less complete cure. For example, if the tumor is pediculated, and lies in the uterine cavity, the pcdiele may finally give way, and the tumor may be expelled; or certain changes may take place in the interior of a tumor, leading either to its disintegration and elimination, or to its conversion into a chalky mass, which, though not eliminated, induces no local disturbances. These spon taneous cures are by 110. means rare, although we can hardly lead the patient to expect them in any special case.