Outlines of the diseases of women / by John Phillips.

  • Phillips, John.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Outlines of the diseases of women / by John Phillips. Source: Wellcome Collection.

    143/332 (page 123)
    Fig. 66. Beyond the fact that a heavy uterus may predispose to pro- lapse, it has nothing to do with causation of the accident: as has already been said, prolapsus uteri is a form of rupture, as is inguinal hernia, of which the sac is the peritoneum, and the passage through which it travels, the outlet of the pelvis, which is bounded by the symphysis pubis in front, the sacral segment behind, and the obturator internus and levator ani muscles laterally. The coverings are formed by the uterus, and the anterior vaginal wall in front, the posterior vaginal wall behind (Fig. 66). Intes- tine is always contained in the sac of a prolapse. Prolapsus uteri may be (a) partial; ($) complete, when the term total procidentia is given to it. Mechanism of Prolapse.—If a woman with complete prolapse of the uterus and vaginal walls is placed on her left side and the mass reduced, and if she is then told to strain, the prolapse will return and pass through the fol- lowing stages :— The anterior vaginal wall ap- pears first at the vulva, with the posterior bladder wall as a cysto- cele; with the bladder come the ureters; the urethra will be sharply curved on itself. The cervix then appears, and lastly Total prolapsus uteri. The uterus in a state of retro- flexion : the intestine, which should be present in the sac, has been purposely omitted. (After Schroeder.) the posterior vaginal and often rectal wall, as a rectocele: the cervix now passes downwards and forwards towards the sym- physis, its orifice looking for- wards; total eversion of the posterior vaginal wall then takes place ; the most posterior portion being extruded first. Considering this process more closely, we find that the cervix follows in its descent the curve of Cams, and that the long axis of the uterus corresponds with that of the pelvic cavity : as it descends, gradual retroversion therefore takes place of the fundus uteri, and it is prolapsed in a state of complete retroversion; above the uterus, and forming a pouch behind it, is the peritoneum and displaced intestine. Replacement must be performed in exactly the opposite way. Prolapse of the posterior vaginal wall is not of necessity a complication of prolapsus uteri.