Prolapsus of the uterus takes place rarely indeed, but from a variety
of causes; for it is occasioned either by a woman’s falling from a
height and pitching upon her bottom, whereby the ligaments are ruptured
which keep the viscus in its position; or by the tearing away of the
secundines, which drag the uterus along with them when they adhere,
as in difficult labour; or by the awkward performance of embryotomy;
or by a blow, or mental emotions, such as when the loss of children
has been communicated, or an irruption of the enemy, or by a dangerous
voyage, or some such cause, by which the uterus has fallen down, owing
to a relaxation of the whole system, or owing to paralysis and atony
of the parts, which happens most especially to those in the decline of
health. It is towards its mouth that it falls down. Some, indeed, have
related that the whole uterus has been prolapsed, which is incredible;
for how could it have been reduced and fixed in its place? Wherefore, we
must first evacuate the hardened fæces by a clyster and bring about a
discharge of the urine, in order that the uterus may be freed from all
compression, and then place the patient in a supine position, having her
bottom elevated, her thighs bent, and her legs separated; and then take a
hasp of wool, in figure and thickness resembling the female vagina, and
this being bound round with a slender piece of cloth, and dipped in the
juice of acacia, or of hypocistis dissolved in wine, is to be applied to
the uterus, and all the projecting part pushed upwards gently, until the
whole swelling is restored to the vagina; after which the pubes is to be
covered externally with a piece of sponge squeezed out of oxycrate; and
the woman is to be laid with her legs stretched out and applied so that
the one may lie over the other. After this, cupping-instruments with much
heat are to be fixed to the navel and the loins on both sides, and things
of a fragrant smell applied. On the third day, while the wool is still
remaining in the vagina, let the woman sit in a hip-bath of dark-coloured
austere wine slightly warmed, or in a decoction of myrtle, lentisk, and
pomegranate-rind. After these things, let the wool be taken away and
another fold applied soaked in the medicine. Cataplasms are to be applied
externally to the hypogastrium, of dates, polenta, or dried lentils, and
pomegranate-rind with oxymel. And every third day let the same thing be
done until the cure be completed. But if the prolapsed part cannot be
reduced, and mortify in the course of time, we may take it away without
apprehending any danger: for they relate that the whole uterus, having
become mortified, has been taken away, and yet the woman lived.
* * * * *
COMMENTARY. This complaint is particularly well treated of by the Father
of Medicine. He has even described the case of a complete procidentia,
when, he says, the uterus hangs down like a scrotum. Hippocrates directs
us to make cold applications to the pudenda; to wash the part with an
astringent lotion, and restore it to its place. He afterwards gives
directions to make the woman lie upon her back with her legs crossed and
tied together; and if the disease be likely to return, he recommends
cupping and pitching of the hypogastrium.
Celsus mentions prolapsus, and recommends for it hip-baths of salt or
astringent water, and local applications of a styptic nature after the
womb has been replaced.
Aretæus, with his usual talent for description, draws a melancholy
picture of a woman labouring under a complete procidentia uteri. He says
it is occasioned by abortions, violent concussion, or severe labour; and
explains very well how this happens from relaxation or rupture of the
ligaments of the uterus.
Our author takes his account almost word for word from Aëtius, who
acknowledges his obligations to Soranus.
Alsaharavius recommends nearly the same plan of treatment as Hippocrates;
and directs us, when the attempts at reduction fail, to extirpate the
womb by an operation. Avenzoar relates a case in which he saw the whole
uterus projecting externally. He did not know the issue, only he was
sure that the disease subsisted for a considerable time. He also relates
another case upon the authority of a friend of undoubted veracity. Haly
Abbas likewise mentions that the uterus sometimes protrudes fairly out,
and enumerates the same causes of the complaint as our author. He relates
that cases have occurred of the whole uterus having become putrid and
been removed entire. Rhases, Avicenna, and Serapion, appear to have
derived all their information from Aëtius and Paulus. Rhases directs us
to bathe the parts with styptic decoctions, to put the woman into a bath
medicated with roses, myrrh, &c., to reduce the womb, and retain it with
compresses soaked in an astringent solution.
Eros recommends baths composed of the decoctions of acorns,
pomegranate-rind, sumach, galls, &c.; also astringent fomentations, and a
cooling diet.
The ancients appear not to have used pessaries made of solid materials,
such as wood and metals.