It ought, also, to be noted that a womb, dis placed from any cause, is liable to be the seat of congestion and other disorders, because of the disturbance to the proper circulation of blood through it which the displacement occasions, and such congestion will then tend to increase the departure from the natural situation.
Symptoms.—Unless in cases of prolapse, where the mouth of the womb appears exter nally, there are really no symptoms by which a patient could decide for herself the nature of her trouble. There are likely to be many which would lead her to conclude that something was wrong with the womb, but none which would enable her to conclude what was the real nature of that something. The existence of a displace ment and its kind can only be determined by a skilled medical man, after he has made an examination by introducing his finger into the passage, and thus ascertaining the position of the organ.
The symptoms that point to such uterine trouble are backache, pains in the loin, dis charge, perhaps pain at the monthly illness. A womb displaced backwards is liable to press on the bowel and cause constipation and piles ; a womb displaced forwards is more apt to give rise to bladder troubles, pain in making water, frequent desire to pass water, &c. &c. There is often discomfort or difficulty in walking. In digestion is extremely common and persistent, and is sometimes the only result of a slight dis placement. Indigestion so caused is almost certain to defy any treatment directed to it, but speedily disappears if the displacement be detected and got rid of. Sterility is common in all forms of displacement, but particularly in those in which the uterus is bent on itself, for the bend blocks the canal of the womb and prevents the passage upwards of the seminal fluid. Further, nerve troubles are in many cases the main pronounced symptoms of such disorder, which, like those of digestion, defy all treatment unless the uterine condition be attended to. Such disturbances of the nervous nystem are more apt to occur in young un married girls; and the hysterical condition into which young excitable girls are sometimes brought by such a cause is not easily overcome.
The treatment of such conditions is in many cases not attended with much difficulty, while in other cases it is by no means easy. In all, as a general rule, very great relief can be afforded, even though a permanent cure is not obtainable. But the treatment can only be properly undertaken by a medical man. It consists in restoring the womb to its natural position, if that is possible. Sometimes it is not possible, because of the very long duration of the displacement having caused the womb to become fixed in its altered position, or because of inflammatory adhesions binding it down.
It is very often possible for the surgeon to replace the Womb simply with the fingers, and more often with the aid of a long slender rod, on a handle, called a sound, the use of which, in skilled hands, ought not to be attended with any considerable pain. The second element in the treatment consists in the introduction into the passage of a small instrument, called a pessary, made commonly of vulcanite, but also of celluloid, or india-rubber, in the shape of a large ring, which is so placed as to support the womb in its restored position. The shape of the pessary varies with the kind of displacement. If it is properly adjusted, it should occasion no inconvenience whatever, the patient should, in deed, be unable to perceive its presence, and it does not require any alteration in ordinary ways of life, does not, for example, necessitate a married woman living a single life, while it remains in the passage. The third element in the treatment consists in the endeavour to restore vigour and tone to the parts, so that in course of time the pessary may be removed with some hope of the womb remaining in its restored position. Such treatment neces sitates attention to the bowels, to the food, to proper exercise, fresh air, &c. Tonics will aid the endeavour ; but the suitable tonic depends on circumstances to be judged by the physician.
Anyone who is wearing such a pessary ought to return from time to time to her medical attendant, and ought to see him without delay if any signs of its presence irritating the pas sage arise. Probably the pessary will require to remain six or eight months, but it ought not to remain longer without the medical man's sanction. Patients have been known to forget altogether the presence of the instrument, and to continue wearing it for very prolonged periods, till it became fixed, impacted by incrusted re mains of discharge, urinary sediment, &c.
While the instrument is being worn, frequent use of the injection by an enema ought to be persisted in. This will not only aid in restor ing the vigour of the womb and neighbouring structures, but by the constant cleanliness will prevent irritation arising from the presence of the pessary. The daily use of the injection is strongly urged. The injection had better be not of warm water only, but of warm water with some added carbolic acid, of a strength equal to one ounce of the acid to every three or four pints of water. The pessary is simply to be regarded as affording a mechanical support till the tendency of the womb to return to an abnormal position is overcome.