Volume 2

A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    made. However, it is nece.ssaiy to bear in mind tlie facts tliat the normal position of the pregnant uterus is one of anteversion or even mobile anteflexion, and that a ceifain degree of retrov’ersion and retro- flexion ‘ can exist without the production of .symptoms. Eflbrts at replacement must be extremely gentle. Henry F. Campbell has repeat- edly expressed his confldence in the method of postural pneumatic reduction in the genupectoral position. This mode of reduction in pregnancy, when the I’etrovcrted uterus is not flxed, with or without manipulation through the vagina or rectum, is of undoubtedly very great value, notwithstanding the strictures of Simpson and Ilart to the contrary. When replacement has been effected, the organ is retained in position hy the cotton-wool tampon, posture, or, in a limited num- ber of cases, by a properly-fitting pessary. Graily Hewitt’s well- known advocacy of anteversion and anteflexion pessaries in this con- dition has not met with general professional approval. It is not at all improbable that the alleged relief experienced after the application of these pessaries in the many cases reported by this observer was merely a coincidence. 2. Local treatment of the vaginal portion constitutes by far the most effective procedure under this heading. M. O. Jones of Chicago many years since suggested the local application of a 10 per cent, solution of argentic nitrate in eases in which some morbid .state was present. Gen- eral attention was attracted to this method by J. Marion Sims. At the present time the plan is employed universally, and Carl Braun regards its efficiency as considerably greater than that of any other single mode of treatment. As practised in Vienna, the woman is placed in the lithot- omy position, and after a vaginal douche Braun’s hard-rubber cylindri- cal .speculum is introduced and the vaginal portion engaged within the field. A 10 per cent, solution of nitrate of silver is poured into the .speculum until the vaginal portion is completely covered. The solution is allowed to remain ten to twenty minutes, when it is decanted. The indication for the use of this method has been generalized in Vienna, so that it is now employed in all ca.ses of .severe vomiting, irrespective of the condition of the vaginal portion, as a purely empirical rc-source. It is seldom nece.ssary to make more than tAvo or three applications. The Aveight of te.stimony in favor of this simple procedure collcctetl fiom inuumerable sources is so great as to make its employment abso- lutely obligatory before re.sort to more radical methods. Bretonneau .suggested the a]>plication of belladonna to the abdomen, in the belief that the vomiting was cau.scd by rigidity of the uterus! Cazeaux smeared the vaginal portion and the vaginal vault with the soft extract. Success attended the efforts of both observers in some cases, while the remedy was without effect in others. Cazeaux rceom- * Bniune’s Frozen Sections, Tab. ii. B.