Contributions to the pathology and treatment of diseases of the uterus / [Sir James Young Simpson].

  • Simpson, James Young, 1811-1870.
Date:
1843-1844]
Catalogue details

Licence: Public Domain Mark

Credit: Contributions to the pathology and treatment of diseases of the uterus / [Sir James Young Simpson]. Source: Wellcome Collection.

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    whether applied to the organ from above or below, that it is diffi¬ cult to ascertain any thing precise with regard to the condition of these parts, either by a common vaginal, or by a hypogastric examination. The obstacles which thus so effectually oppose an accurate and complete tactile investigation of the surfaces and walls of the body and fundus of the uterus, may be in most cases, in a great measure, overcome by the aid of the Uterine Sound, if we employ it for the double purpose—first. Of giving sufficient resistance to the organ for its exploration by the fingers; and, secondly, Of altering the position of its parts so as to bring them each succes¬ sively within the reach of tactile examination. When the pliable and mobile uterus is held steady by the sound being placed in its cavity, and the central axis of the organ is for the time being, thus rendered, as it were, firm and solid,— the examination of its external surface, and of its walls, becomes a matter of far more certainty and accuracy than if we had the organ indefinitely yielding and receding before each slight touch of the fingers. But besides thus rendering the organ fixed and resistant for our examination, the Uterine Sound will, as a diagnostic means, be found of still greater use and importance, by the control which its presence in the uterine cavity gives us over the position of the whole organ, and by its enabling us to alter at will the situation of the viscus to such a degree, that we can in succession bring within the range of a tactile investigation, different parts of its external surface and parietes, that are generally considered to be entirely beyond our reach. In reference to this remark it must be specially kept in mind, that in the healthy state the uterus is so loosely fixed in its situation in the pelvic cavity, that its position is capable of being changed to a very considerable ex¬ tent, without incommodity or injury, by such exterior influences as may naturally or accidentally act upon it. Its position is so far constantly changed by the varying states of distension of the bladder and rectum. Under voluntary efforts of straining, it can in general be readily pushed down half an inch or an inch in the cavity of the vagina. It may be drawn down by instru¬ ments till the cervix reach the external parts themselves, or even protrude beyond them—a circumstance which facilitates im¬ mensely the operation of excision of this part of the organ. In consequence of the same anatomical peculiarity, we are able, through the use of the Uterine Bougie, to move the organ up¬ wards, forwards, &c., to such degrees as are requisite for a com¬ plete hypogastric examination, without in general causing any marked inconvenience or pain to the patient.J 1 In corroboration of the statements in the text with regard to the natural mobi¬ lity of the uterus, 1 would beg to fortify the remarks I have there made, by quot-