Recent Literature A Clinical Manual of Diseases of the Eye, including a Sketch of its Anatomy . By D. B. St. John Roosa, M.D, LL.D. pp. 621. New York: William Wood & Co

1895 Boston Medical and Surgical Journal  
tioued patients that it was best not to become pregnant for a year, yet he had never seen abortion or trouble arise from it. Dr. Cleveland had performed ventral fixation frequently, but preferred Alexander's. Make a short incision, draw the ligaments out sufficiently, usually about four inches, aud in order to make their attachment quite firm, use their extremities as sutures, besides stitching them with silkworm gut at the pubes. The discussion on the three papers was opened by Dr. Davenport,
more » ... f Boston. Retroflexiou of the uterus frequently was only temporary, and even when it had existed for years it failed ofteu to cause symptoms until some complicating condition arose. Alexander's operation did not come into the discussion where there were adhesions. In simple rétroversion he would prefer Alexander to ventro-fixation. The former, however, did not always relieve the symptoms. The frequency of hernia had been underestimated ; it was apt to be followed by a feeling of numbueus at the site of the scar. The cause of the displacement was not the weakness of the round ligaments, and these sometimes failed to hold the uterus in position owing to the abnormal condition of the cervix, of the utero-sacral ligaments, etc. Dr. Ely Van De Warker, of Syracuse, referred to his paper of about twenty years ago, first describing the use of the intra-uterine stem, for which he then received very severe criticism. Time, however, had changed the minds of his critics. The instrument was of great value in certain cases. The speaker thought Alexander's operation, with which he had personally had considerable experience, was not founded on scientific principles, and had proven unsatisfactory. Some pathological factor aside from the round ligaments had caused the retro-displacement aud prolapsus, and this should receive one's attention. Dr. H. C. Coe, of New York, thought Dr. Van De Warker spoke from false premises. The round ligaments were never intended to hold the uterus up as a dead weight. They were shortened simply to prevent it falling backward. There was no comparison between Alexander's aud veutro-fixatiou, for the latter was to be undertaken only where the abdomen had, for some other reason, already been opened. Dr. Thomas Addis Emmett, of New York, had early been given opportunity to introduce the finger into the vagina and feel the liftiug of the uterus when Alexander was performing his operation, and as a consequence of that experience had never done the operation. The trouble was due to the prolapsus, not the version ; to straightening out and engorgement of the vessels ; and what relief came from pessaries, etc., was due to overcoming prolapsus, not to overcoming rétroversion. Dr. W. M. Polk, of New York, said Alexander's operation had been with us so long, and had been performed so many times that there could no longer be any question of its efficiency iu relieving these cases. It could even be done where formerly it had been considered necessary to open the abdomen, for by first making an incision into the vaginal cul-de-sac the adhesions could be freed and the Alexander then performed. Dr. J. M. Baldy, of Philadelphia, spoke of the necessity for treating the uterus for inflammatory conditions, etc., and stated that in some cases of prolapsus hysterectomy was indicated. Dr. George M. Edebohls, of New York, had had some additional experience with the operations described in his paper two years ago for the relief of uterine prolapsus, and stated that it had» been quite satisfactory. It had been said that when the round ligaments were not found it was always the fault of the operator. He had himself once believed this, and doubtless it was usually true, but he had lately had two cases in which he had opened the abdomeu on failing to find the round ligaments during Alexander's, and it was shown that they failed to proceed downward iu the usual direction after reaching the internal ring, but passed outward. (To be continued.) Recent Literature.
doi:10.1056/nejm189511071331907 fatcat:z3gyuhm4gjbbdmrunqoqnkocfq