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S E C TI O N VI.

Descent, or Bearing down of the Womb.

THIS happens when the womb falls

down through the relaxed vagina or passage, and appears externally in the form of a tumor.

It has been the common opinion, that the womb is retained in its natural situation by two sorts of bands or ligaments peculiar to it, and that this disorder is occasioned by a weakness of those parts ; but, from the most particular examination, they appear to have very little sustaining power, and experience Thews, that a descent of the womb may happen without any fault of those ligaments.

But, allowing they were affected and their strength impaired, even then the womb could not possibly descend to the external

parts,

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parts, without an uncommon dilatation or enlargement of the vagina; and on the contrary, so long as that part is endowed with fufficient resistance, no bearing down could possibly follow, although the ligaments had lost their sustaining power,

The immediate cause of this disorder must, therefore, be owing to a prețernatural weakness and enlargement of the passage leading to the external parts.

Hence it may proceed from any cause which tends to relax the vagina and render it so weak as to allow the womb, in whole, or part, to intrude or press down thro' its enlarged cavity ; when the first happens, it is called a descent of the womb, but if only the last, 'tis termed a bearing down,

In whatever degree the disorder prevails it will always be rendered worse by the upright position of the body; for then, the weight of the womb rests more immedia ately upon the affected part,

If to this principal cause of the disease, other accidental causes are added, such as a cough, straining to lift heavy weights, or any violent efforts of the body, which act immediately on the womb; it will then be aggravated and rendered more difficult of cure.

Agreeable to those circumstances, a bearing down, and sometimes an entire descent of the womb happens in conse. quence of hard labours, where 'the fibres of the vagina have been so overstrained, as not easily to be restored to their natural strength and firmness, especially in those of delicate constitutions; on the contrary, virgins are seldom affected with it, except they are of a habit of body uncommonly lax and weak, or where the womb is in a difeased state.

The fluor albus also difpofes women to this complaint; because the parts contiguous to the womb, gradually lose their resisting power by the continuance of the

discharge

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discharge, which not only exhausts the strength, but so macerates and relaxes, as to render them preternaturally soft and yielding

The disorder called bearing down is ge nerally flight at first, producing an uneasy sensation, as if something was pressing upon the affected part; but, where there is an in. tire descent, the symptoms are much more severe ; for, the bladder being connected with the Womb, is then pulled down with it and occasions a difficulty of urine, attend, ed with pain.

This inconvenience may be remedied by presling up the tumor, when the patient is placed upon a bed or couch, so as to restore the bladder to its natural ftuation, which is a much more proper and eligible method, than that of passing the catheter to draw off the water; since in this particular case, the instrument would meet with great resistance; and occasion excessive pain and inflammation of the urinary paflage.

When

When the tumor is large, and descends fo low as to appear externally, it is apt to swell and ulcerate ; but this does not pro. ceed, as generally fupposed, from the acri. mony or sharpness of urine diffusing itself over the tumor, but from the strangulation of vessels at its upper part ; by which the course of blood is obftructed, even fometimes to such a degree as to produce mortis fication.

The descent of the womb is attended with many circumstances of the most diffresling nature to delicate women who are, unfortunately, most subject to it.

In bad habits of body, there have been instances where it ended fatally, by producing a scirrhus or cancer. In a word, it hinders the regular returns of the menses, brings on fluor albus, prevents conception, and, at last, by perverting the natural functions of the womb, destroys the constitution.

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