. Diseases of women. A clinical guide to their diagnosis and treatment. istherefore often present. The symptoms are usually increasedbefore and during menstruation, in consequence of the con-gestion of the pelvic organs which precedes this function, butmenstruation otherwise is unaffected. Treatment.—These symptoms can be relieved by supportto the perineum. Vaginal pessaries are useless, because allthat a vaginal pessary can dois to keep the vagina cases in which there isdescent of the uterus, with in-version of the upper part ofthe vagina, vaginal pessaries,which keep the vagina e
. Diseases of women. A clinical guide to their diagnosis and treatment. istherefore often present. The symptoms are usually increasedbefore and during menstruation, in consequence of the con-gestion of the pelvic organs which precedes this function, butmenstruation otherwise is unaffected. Treatment.—These symptoms can be relieved by supportto the perineum. Vaginal pessaries are useless, because allthat a vaginal pessary can dois to keep the vagina cases in which there isdescent of the uterus, with in-version of the upper part ofthe vagina, vaginal pessaries,which keep the vagina ex-tended, are serviceable ; but in Fig 23.—Perineal support,these cases there is no suchcondition. Support to the perineum is wanted. The readiestway of giving this support is by an ordinary napkin, verytightly fastened. The patient may find difficulty in keepinga napkin adjusted tightly enough. If so, advise an abdominalbelt with a perineal pad (Fig. 23). These cases are important, because in them we havethe phenomena of prolapse in their slightest and simplest. 114 DISEASES OF WOMEN. form; and they therefore teach us the symptoms whichprolapse does and does not cause. The test, whethersymptoms be due to alterations in the position ot the pelvicorgans, is that they should be relieved by correcting theanomaly which is assumed to be their cause. In these casesthis can be done, and when it is done the symptoms are atonce and completely relieved. The mechanism of uterine prolapse.—If the condition goesfurther, either (1) the uterus sinks into the vagina, invertingthe upper part of that canal: or (2) the anterior vaginal wallsinks down, and pulls the uterus after it. The rule is thatthe anterior vaginal wall comes down first: this drags downthe cervix uteri, and the cervix drags down the posterior vaginalwall. Consider now the morbid change which begins the of the vagina.—You must not think thatbecause a patient complains of her womb coming down, therefore
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