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Displacements of the Womb

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Displacements of the womb are exceedingly common, commoner than is generally supposed, frequently existing without giving rise to any marked symptoms. At the same time the dis placement may give rise to many and pro nounced symptoms, which no treatment does anything to relieve except that of replacing, as nearly as possible, the womb in its original position.

The womb is suspended, as it were, in the middle of the pelvic cavity (p. 63), with the bladder in front of it, and the termination of the bowel behind it It is maintained in its position by its attachment to these organs, and by bands or ligaments of its own, and in its situation is freely movable in various direc tions. The upper end of the body is directed upwards and forwards, and the mouth down wards and backwards, so that, when the person is in the erect position, it may be said to incline forwards.

Prolapse of the Womb.—The womb may not be maintained at its ordinary level, but sink somewhat downward*, for example, because of enlargement or congestion rendering it too heavy for its supports, or because the supports have become stretched and weakened. This is called prolapse, and will vary in degree accord ing as the womb sinks lower and lower. If it sink greatly, the mouth of the womb may appear at the external opening, and, in very extreme cases, it may appear entirely outside, which form is called procedentia. It naturally will drag down with it the wall of the bladder to which it is attached in front, and the wall of the bowel to which it is attached behind.

Retroversion.—Further, instead of being inclined forwards, as in the ordinary position, the womb may be tilted backwards, in which case the body looks backwards and the month forwards, and this backward tilting also varies in amount. Retroversion is the name applied to this displacement. The womb itself, though inclined backward, remains straight.

Retroflexion, however, is a condition in which the organ is bent upon itself, bent back wards on itself, so that the body of it is directed back wards, the mouth maintaining pretty nearly its proper position. It is doubled ou itself.

Anteverslon is the term when the organ, remaining straight, is unduly tilted forwards, so that the womb tends to lie across the cavity.

Anteflexion signifies that it is curved or bent forwards on itself.

The causes of such altered positions are numerous. Congestion, overgrowth, the pre sence of tumours, &c., adding to the weight of the organ, tend to displace it. A very common cause of this kind arises when a woman begins to go about too soon after a confinement. The womb has not had time to return to its natural size, and its supports, stretched and weakened by the pregnancy, are unable to bear up the unusually heavy womb, and thus it assumes an improper position. General ill health may so diminish the vigour of the supports, and diminish the tone of the womb itself, as to occasion a "displacement." Further, any undue pressure may force it out of place, and if this be long continued it does not get a chance of returning tolts natural place. Undoubtedly a great cause of such pressure is the undue weight of clothes and tight lacing. These diminish the size of the belly cavity by pinching in the waist. The bowels are pressed upon, and to find room press downwards on the womb, &c., forcing it out of position, and keeping it out of position. The pressure of a tumour in the belly may act in the same way. A tumour pressing upwards from below may also displace the womb, but in a different direction. As another example, the frequent existence of a distended bowel or overfill' bladder, apt to occur in women, may occasion it. Undoubtedly falJs, violent exertion, and such agencies are often at work in pro ducing such disturbances of position. In women who have borne children, the womb is often deprived of its due support from below by rupture of parts during labour, and it is then apt not to be duly maintained in proper place.

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