Page:Clinical Lectures on the Diseases of Women.djvu/217



subject of this lecture is one of the most important among the diseases of women—Procidentia of the Uterus. It is of the simplest kind, nearly purely mechanical, quite as much so as a dislocation of the shoulder, or a hernia. There are a variety of other views held which may be called vital, connecting it with some diseased condition as a cause, but I am satisfied that it is mainly mechanical. In the descent of the uterus there is a variety of degrees. The first is generally called descent; it is the slightest degree. The second is prolapsus, in which the neck of the womb is near the orifice of the vagina. The example before us is, how- ever, in the most important degree, procidentia, a falling forth from the body.

When the patient came to us the womb was not procident, it was merely in a condition of prolapse, lying on the perineum, not outside the woman's body. But if she walked about, or made any effort, it came outside; therefore it is classed among the cases of procidentia of the womb.

Now, what makes a woman's womb fall out of her body? To investigate this, we must inquire what keeps it in its place. The most important cause is the pressure relations of the abdomen. The womb floats. Suppose in the corpse of a healthy female you open the abdomen, the womb is then always found in a state of descent, because the destruction of the entirety of the abdomen robs it of its