A case of complete inversion of the uterus : with remarks upon the modern treatment of chronic inversion / Clifton E. Wing.

  • Wing, Clifton E. (Clifton Ellis)
Date:
[1879?]
Catalogue details

Licence: Public Domain Mark

Credit: A case of complete inversion of the uterus : with remarks upon the modern treatment of chronic inversion / Clifton E. Wing. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    was put upon full doses of Tr. Fcrri Chlor., and ordered copious hot-water vaginal injections several limes daily. These were continued 5 days, when on second examination, the tumor was found much less tender, less congested, in fact now rather pale and showing very little tendency to bleed when hand- led. That the tumor was the inverted uterus was sufficiently plain without, resorting to the various methods of verifying the diagnosis, such as rectal touch, sound in the bladder, etc. etc., which are laid down in the books. These would have caused pain unless an anaesthetic had been used, and were not adjudged necessary in view of the method of treatment I was about to employ—a method which in itself is an excellent means of diagnosis. The inversion was complete ; in fact, anteriorly, it even involved the upper part of the vagina. I had previously determined to treat the case by continued pressure ap- plied to the inverted fundus. Thinking I might find the stem and cup figured by Barnes, or some stem supporter which I could make use of, I ap- plied at the various instrument dealers, but did not succeed in finding anything which suited my purpose, and finally employed a common old-fashioned wooden stethoscope, as a stem to go into the vagina and press upon the uterus, tying strong sheet rubber over the open larger end (the end applied to the chest in auscultation), and thus making a soft cushion at that end. The other end projected from the vulva. Pressure was obtained by using two pieces of common elastic tubing passed between the thighs, where they were tied by the middle to the outside end of the stethoscope, the ends being drawn tight and attached in front and behind to a waist belt. I found that by regulating the tension of these elastic bands, not only could the amount of pressure be easdy controlled, but the direction of the force be perfectly managed. In these respects nothing better could be wished for; but under the pressure the sheet rubber which I had stretched across the open end of the stethoscope became so much depressed that the sharp rim of the latter was going to cut into the uterine tissue. I therefore substituted for the stethoscope a piece of wood of much the same shape (for after the practical trial I did not see how this could be improved), but solid, the upper end (i. e. the end applied to the tumor) being a little concave that it might not readily slip to one side, and for the same reason being made large enough to till the calibre of the vagina. The evening of the second day there was evidently some gain. A cavity of the neck now existed all around the inverted fundus, and it was of sufficient depth to receive the latter enough to prevent it from slipping about in the vagina, i. e. it held it so well in position that pressure must act in the right direction. Therefore as the large end of the first re- positor was rather uncomfortable for the patient from distending somewhat the vagina, I made use of a second one, the upper end of which was of less diameter and could be employed to follow the fundus up inside the cervix. The upper part of this second one was also made of the same diameter for several inches from the upper end, that the cervix having been passed the latter should not contract and cause trouble in the removal of the instrument, as has several times been the case where a cup and stem have been used. The evening of the third day the patient felt a little restless. The pulse, which was at 96 when the process began, ran up to 108. She complained of being tired. To insure her a quiet night (she had had good nights so far, sleeping well), I gave her a i gr. dose of morphine, which was all the medi- cine, with the exception of the Iron tonic, which she received. She slept well, but was waked up in the middle of the night by feeling something jump in- side, as she expressed it, and she immediately found that the pressure from the apparatus had ceased. When seen in the morning, she was feeling nicely ; had no pain, and her pulse was again 96. On examination, I found the uterus replaced, and the end of the instrument extending up into its cavity. I had not anticipated so speedy a result, and not being supplied with my proper instruments, in order to assure myself before leaving the patient that there was no partial inversion still left, I improvised a bougie by cutting off the end of a broom handle and smoothing it with sand-paper which happened to be at hand. This I passed without difficulty into the canal of the uterus, to the depth of 31 inches, and thus proved that the resposition was complete.