Mechanical Appliances in Uterine Surgery
Boston Medical and Surgical Journal
In a previous article we considered and classified the causes of misplacement of the uterus, defined the terms mechanical appliances, and described the structure, form, and principle of application of the most important. We are now prepared to ask (1) in what cases they are beneficial ; (2) when they may be dispensed with ; and (3) when they are positively injurious. These inquiries can be more satisfactorily answered by citing cases from our record-books in illustration of the particular class
... he particular class under consideration. I. CASES IN WHICH MECHANICAL APPLIANCES ARE BENEFICIAL Oil EVEN INDISPENSABLE. Case I. Mrs. B. had had six abortions, four of them having taken place since the birtli of her last child ; and when she came under my care she was threatened with a recurrence of the same accident. On examination, the uterus was found completely retroverted and flexed, enlarged as in the second month of pregnancy, and exceedingly sensitive, with a slight discharge of blood from the os uteri. The patient was put to bed, and kept under the influence of opium for five days, at the end of which time the uterus was so tolerant that it could be replaced without serious danger of abortion. This was done by bi-manual manipulation, the patient lying upon the back. A Hodge rétroversion closed pessary was introduced. The patient derived great comfort from the appliance, and three months afterwards, the uterus having risen out of the pelvis and all danger of a recurrence of the accident having passed, the pessary was . removed, and she went on to the full term of her pregnancy. In this case the cause of the previous abortions had undoubtedly been the malposition of the uterus; wedged into the hollow of the sacrum, as it enlarged the tendency to abortion became greater and greater. The patient being very anxious to havo another child, she having but one living, it was a matter of great importance to her whether she could complete her term of pregnancy, or whether she must abort as on former occasions. If, then, we had replaced the uterus and had not used any mechanical appliance to retain it in position, it would almost certainly have returned to its retroverted state, and a recurrence of the threatened accident would have taken place. To remain quiet in bed until the uterus should reach that size which would enable it to rise out of the pelvis hud been repeatedly tried in 1 Concluded from page 279.