cause and effect; and it can be only on a recognition of this relation that we can apply remedies with any certainty, or look with any confidence for a favourable issue. Displacement forwards or backwards, and enlargement of the uterus, from whatever cause,—whether pregnancy, hypertrophy, inflammatory engorgement, distension by fluid or by hydatids, polypi, or scirrhus, or any other disease-alike tend to injuriously affect the rectum. As displacement may occur without enlargement of the uterus, it may operate singly in inducing rectal disease; but more often the two conditions concur, and it is then chiefly that the mischief is so considerable. The evils, too, will be greater when, with retroversion, engorgement of the body of the uterus, and with anteversion, that of its neck, go together. On the other hand, enlargement, without deviation of the womb forwards or backwards, may, and oftener does, act singly in provoking disease of the rectum, than either of these displacements does without it. The conditions of the uterus under consideration act on the rectum injuriously in two ways: first, by mechanical pressure; and, second, by inducing vascular disturbance like that present in themselves. An enlarged uterus drags on its lateral ligaments, elongates them, subsides lower down in the pelvis, and so comes to press on the lower bowel, to interfere with its muscular action and the circulation through its bloodvessels, and to irritate its mucous lining. At the same time any hyperemic state of the uterine vessels causes an increased fulness of the hæmorrhoidal, and a determination of blood to them. Thus, by reflecting on the anatomy of the parts, it will easily be understood why and how diseases of the rectum, such as hæmorrhoids, prolapsus, fissure, stricture, fistula, as well as disordered functions of the bowel, as constipation, dysenteric irritation, &c., do sometimes result directly, either from the mechanical pressure of an enlarged uterus, or simply from the derangement of the hæmorrhoidal circulation, resulting from uterine disease. By retroflexion and retroversion, the fundus uteri is thrown backwards against the rectum, and will consequently exercise an amount of compression on that viscus, according to its degree, to the bulk of the uterus and the capacity of the pelvis. Retro CCdl G.H Ford hith Normal condition of the Pelvic Viscera a Symphysis Pubis b The Bladder c Uterus d Rectum e Vagina. Ford & West Imp Plate M |