Session 1877
1877
The Lancet
795 much too frequently. He had known many pelvic pains referred to displacement when the uterus was in normal position. He had found Hodge's pessary and intra-uterine stems of great value. He had seen no ill effects arise from the stem pessary, and he had always been able to intro-! duce them without dividing the os uteri, as Smee had advocated, both to allow of its passage into the uterus, and to assist in curing the displacement.-Dr. WYNNE WILLIAMS did not recommend stems in retroflexion,
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... chiefly in anteflexion. Thinning occurred on the concave side of flexion. He recommended reposition of the uterus by the sound, and the introduction of a Hodge while the sound was in the uterus.—Dr. WILTSHIRE thought the Hodge efficient if properly used. Stems were sufficient, but dangerous. He recommended the use of the sound and the prone postion.-Dr. BEIGEL lamented the want of pathological knowledge. He had examined 500 uteri post mortem, and found flexion only ten or twelve times, and no change whatever in the uterine wall, no thinning or microscopical change. The sound could not be introduced in some cases because the canal was closed. Inflammation of uterus did not favour the cure of flexion. Irritation of uterus set up inflammation. The only means of cure was a stem.-The PRESIDENT said it was remarkable in what different lights the uterus was regarded. By some it was looked upon as universally sympathetic, while others looked upon it as an organ which would stand any amount of maltreatment. He could not reconcile these views. Sydenham said it was the duty of those who practised medicine to find out indications for treatment rather than special remedies for this or that condition. The great point to aim at with regard to flexions of the uterus was to distinguish the different classes of these displacements, and lay down rules when treatment should not be adopted, because unnecessary or not beneficial. Great ingenuity had been shown in devising mechanical contrivances, but this may lead to mischievous practice. It should be remembered that the Society should lead the medical profession in a particular branch. The result of Dr. Braithwaite's work was hardly such as to be encouraging. There are some cases which are found out accidentally, and do not require treatment ; in others the suffering is connected with congestion. Others, again, do not bear mechanical treatment because of the presence of adhesion. Virchow showed that thinning of the uterine wall took place on the concave side of the flexion, and brief treatment could not cure such a condition. Then a condition found so rarely post mortem as flexion is, according to Dr. Beigel's observation, cannot be of very great importance. Stems are objectionable because of the risk of inflammation. The great principle of treatment should be not to do harm if good cannot be done.-Dr. BRAITHWAITE stated that the treatment described by him should be followed in exceptional cases only. Hodge's pessary is usually efficient, but in some cases it fails, and recourse must be had to stems. Cure was not effected in four days, but the uterus was placed in position for recovery.
doi:10.1016/s0140-6736(02)40682-4
fatcat:qljpes7lljhz7dh4qj5dvwaspy