SECTION VI.

Defcent, or Bearing down of the Womb.

THIS happens when the womb falls down through the relaxed vagina or paffage, and appears externally in the form of a tumor.

It has been the common opinion, that the womb is retained in its natural fituation by two forts of bands or ligaments peculiar to it, and that this diforder is occafioned by a weakness of thofe parts; but, from the most particular examination, they appear very little fuftaining power, and experience fhews, that a descent of the womb may happen without any fault of thofe ligaments.

to have

But, allowing they were affected and their strength impaired, even then the womb could not poffibly defcend 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 refiftance, no bearing down could poffibly follow, although the ligaments had loft their sustaining power,

The immediate caufe of this disorder muft, therefore, be owing to a preternatural weakness and enlargement of the paffage leading to the external parts.

Hence it may proceed from any caufe which tends to relax the vagina and render it fo 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 laft, 'tis termed a bearing down.

In whatever degree the disorder prevails it will always be rendered worse by the upright pofition of the body; for then, the weight of the womb refts more immediately upon the affected part.

If

If to this principal cause of the disease, other accidental caufes are added, fuch as a cough, ftraining 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 thofe circumftances, a bearing down, and fometimes an entire defcent of the womb happens in confe. quence of hard labours, where the fibres of the vagina have been fo overftrained, as not easily to be restored to their natural strength and firmnefs, especially in those of delicate conftitutions; on the contrary, virgins are sfeldom affected with it, except they are of a habit of body uncommonly lax and weak, or where the womb is in a difeafed state.

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

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discharge, which not only exhausts the ftrength, but fo macerates and relaxes, as to render them preternaturally foft and yielding.

The diforder called bearing down is generally flight at first, producing an uneasy fenfation, as if fomething was preffing upon the affected part; but, where there is an intire defcent, the fymptoms are much more fevere; for, the bladder being connected with the Womb, is then pulled down with it and occafions a difficulty of urine, attended with pain.

This inconvenience may be remedied by preffing up the tumor, when the patient is placed upon a bed or couch, fo as to reftore the bladder to its natural fituation, which is a much more proper and eligible method, than that of paffing the catheter to draw off the water; fince in this particular cafe, the inftrument would meet with great refiftance, and occafion exceffive pain and inflammation of the urinary paffage.

When

When the tumor is large, and defcends fo low as to appear externally, it is apt to fwell and ulcerate; but this does not pro ceed, as generally fuppofed, from the acri mony or sharpness of urine diffufing itself over the tumor, but from the ftrangulation of veffels at its upper part; by which the courfe of blood is obftructed, even fometimes to fuch a degree as to produce morti. fication.

The defcent of the womb is attended with many circumftances of the most diftreffing nature to delicate women who are, unfortunately, most subject to it.

In bad habits of body, there have been inftances where it ended fatally, by producing a fcirrhus or cancer. In a word, it hinders the regular returns of the menfes, brings on fluor albus, prevents conception, and, at last, by perverting the natural functions of the womb, deftroys the conftitution.