The married woman's private medical companion

by A. M. Mauriceau

FALLING DOWN OF THE WOMB.

This is a much more common complaint than the former, and takes place in women of every age, and every rank. As its name implies, it consists of change in the situation of the womb, by which that organ lies much lower than it ought to do. In some cases it absolutely protrudes entirely without the parts. The slightest degrees are styled bearing down; and the more violent ones descent or falling down of the womb.

In general, the first symptom of this complaint is an uneasy sensation in the lower part of the back while standing or walking, with now and then a kind of pressure and bearing down.

If these feelings be disregarded, the complaint increases, and the patient becomes incapable of making water without first lying down, or pushing up a swelling which seems to stop the discharge of urine; and if the disease continues to increase, the womb is actually forced out of the parts, and takes on the form of a bulky substance hanging down between the thighs. This extreme degree of the complaint can seldom happen, excepting in women who have had a great many children, but the less degrees of it occur occasionally in very young unmarried women.

The causes of descent of the womb ought to be known to every woman, as many of them may be avoided. Every disease which induces weakness of the habit in general, or of the passage leading to the womb, in particular, must lay the foundation for the complaint. Frequent miscarriages, improper treatment during labour, too early or violent exercise after delivery, are in married women, the most frequent circumstances by which falling down of the womb is produced. In the unmarried, it is apt to take place in consequence of violent exercise, as in dancing, riding, &c., while out of order, a fact that ought to be impressed on the mind of every young woman.

In the treatment of this complaint, the means must be adapted to the degree of its violence. When the descent is inconsiderable, and the case is of recent date, the daily use of the cold bath, invigorating diet, very moderate exercise, and the injection of any mild astringent liquor into the passage, evening and morning, will probably prove successful. But should the disease be in a great degree or of long standing, a course of tonics, with the frequent use of astringent injections, as a strong solution of alum in water, or decoction of red oak bark, must be added to the above means.

Dr. Leak advises, that after the parts are reduced, the intention of contracting the relaxed vagina so as to prevent its future descent, may be effected by the frequent use of the following astringent injection. Take of alum, and white vitriol, each, one drachm, boiling water, one pound, mix and filter through paper. Inject it into the vagina, milk warm, with a womb syringe. At the same time endeavour to strengthen the whole bodily system by nourishing diet, and tonic medicines.

When the complaint resists such remedies, or when, from its degree, it may appear unnecessary to employ them, the only relief which can be afforded, unless the womb become pregnant, is to be obtained by wearing an instrument called a pessary. It is made of wood or ivory, and if properly adapted to the passage, and of a proper construction, it can be worn without much inconvenience, and it never occasions pain. Certain attentions are however necessary, whenever such an instrument is used. Thus, the pessary should never be allowed to remain in the passage above a few days at a time, otherwise it becomes the source of great irritation. It should, therefore, be occasionally withdrawn on going to bed, well cleaned and reintroduced in the morning, before the patient rises. In some instances, after a pessary of a certain size has been worn for several months, one of a smaller size becomes better adapted to the passages, and in other cases one of a larger size is required.

Sponges of such a size as, when expanded, fill up the cavity of the vagina, are very good pessaries. They support the uterus, and, by putting a string through them, the end of which is to be left hanging out of the os externum, the woman can take them away and apply them herself very conveniently.

To answer this purpose, a fine sponge, wrung out in alum water, may be dried in a compressed state, and cut into any convenient form, so as to be introduced as high as possible: this will act by its astringency, and by its pressure, in a gentle and uniform manner. During the use of this application, an astringent injection may be used twice a day; and the sponge tent should be made gradually smaller as the vagina contracts.