§ 4. Tumors.—It is unnecessary in such a short summary to separate the fibrous and the polypous tumors, because their re cognition is almost wholly a question for the professed accoucheur. They are both frequently marked by the recurrence of occasional hemorrhage, by bearing down, sense of pain and weight, &c., which call attention to the condition of the uterus itself. A fibrous tumor may often be felt through the abdominal walls, just at the brim of the pelvis, when it is situated in the body of the organ : its central position and its elevation serve to distinguish it from commencing ovarian tumor;. polypous growths can only be de tected by examination per vaganam.
Both diseases may continue for a long period without the possibility of their being actually traced. We infer the probability of polypus when occasional hemorrhage is accompanied by constant leucorrhcea, and a sense of bearing down; when at the same time, the os uteri is partly open, and there is no hardness or irregularity of its lips. A fibrous tumor, again, may be sus pected when there is menorrhagia unconnected with general disorder, or traceable alteration of parts, and which has not been attended with pain ; and when, in course of time, this is followed by discomfort in micturition, or by bearing•down pains and efforts at expulsion.
§ 6. Prolapsus.—The sense of weight and bearing down is con stantly produced by actual displacement of the womb. The his tory very generally dates from previous pregnancy, when the pa tient got up too soon, or continued in an enfeebled state at the time when she was allowed to get up ; the ligaments fail to retain the organ in its proper place, and it falls by its own weight. Sometimes in women who have never borne children an unusual tension of the abdominal walls, by strain or violent effort may cause descent of the uterus, just as it may cause hernia. Occa sionally it is produced by the constant carrying of heavy weights; and the fact Is only to be ascertained by examination.
Of late years we have heard a great deal of forms of prolapsus, which very often exist only in the mind, perhaps we may venture to say, in the mouth of the practitioner, anteversion, retroversion, anteflexion, retroflexion; the for mer implying a displacement of the whole organ, the latter, that its body becomes flexed or bent on itself. No doubt retroversion does occasionally occur, as a very painful and annoying form of displacement, pressing upon and greatly interfering with the action of the rectum ; anteversion must be a very rare condition considering the daily and hourly distension of the bladder, which lies in front of the uterus. Antefiexion, as has been pointed out by some French physiologists, is the natural form of the womb in early life, and though it may continue abnormally after pregnantly, or may be even exag gerated, it seems absurd to assign any importance to it except when aggra vated by the existence of a tumor, or abnormally fixed by peritoneal adhesion.
Retroflex ion is the moat unimportant among the changes of position.
Prolapsus may be limited to the walls of the vagina, or they may be involved in the descent of the womb. This often gives rise to more annoyance to the patient in walking or making any exertion than prolapsus uteri when free from such a compli cation. One of its most prejudicial consequences is when a por tion of the bladder descends into the interior of the fold of mu cous membrane, rendering it impossible to evacuate its contents completely ; the same sequence of events occurs as when the bladder is paralyzed ; the urine decomposes, irritation of the bladder is set up, unhealthy mucus is secreted, and chronic cys titis is established.
Valuable information in regard to diagnosis is also gained from an opposite condition, when the os uteri is found unusually high up. It is constant in pregnancy after the fourth month ; it is often found when there has been local inflammation of the sur rounding tissues ; and it affords one of the most complete con trasts between large ovarian dropsy and ascites, because in the latter the uterus is always 5 6. Congestion and very prominent place has been given by certain practitioners to inflammation and ulcera tion of the os and cervix uteri ; yet they are comparatively rare, and, as substantive diseases, unimportant. They do, indeed, ac company other conditions which may be of serious moment to the health of the patient, but in their uncomplicated form their ephemeral notoriety will ere long have passed away ; true patho logy and useful practice have been neither advanced nor bene fited by those who have made them their study; and posterity will regard very differently the inventor of the stethoscope and the speculum.
Simple congestion may be the consequence of over-excitement., or of sudden suppression of the catamenia; it may be excited by irritation of the rectum, or it may only be an exaggeration of that normal condition which produces the menstrual discharge; it is often associated with tumors of the uterus, or with prolapsus of the organ. After repeated pregnancy, enlargement, fissure, or irregularity of the os uteri may be often detected, to which the name of congestion is evidently inapplicable ; but sometimes enlargement of the whole organ continues after delivery, and a state of venous congestion is maintained, which may result in hypertrophy or induration.
Inflammation, as applied to a muscular structure, is generally a misappropriation of language; the event we know to be a rare one. When acute or subacute symptoms are present, their true source is in the mucous membrane which lines its interior, or the serous layer which incloses the womb and its appendages. Such circumstances occur as a consequence of the puerperal state, and there is no more frequent cause of partial peritonitis (see Chap.