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ranging all the way along the hystero-neurotic series from simple hysteria to absolute mania. To restore the dislocated organs under these circumstances is oftentimes to afford instantaneous relief. The most effectual, safest, and simplest method of replacement is, I asseverate, through the medium of the knee-chest posture. The reversed gravitation of the abdominal viscera, with a little assistance a tergo, will, in many instances, carry uterus and ovary to their places. We should proceed at once to occupy their former site with the cotton tampons in the manner already described, and, after all tenderness of the parts has subsided, a hard-rubber pessary should be fitted.
For the proper adjustment of a pessary in any backward displacement of the uterus, or in prolapse of the ovaries, the knee-chest posture is believed to be invaluable. It is incomparably superior to any other position in that supervision of the pessary so necessary to its successful employment. The pessary, no matter how well fitted, nor how well it seems to keep its place, must be removed at frequent intervals, and the vagina thoroughly inspected, that any ulcerations, erosions, or abrasions, which it may have caused, may be speedily detected. This inspection can be more thoroughly made in the genupectoral posture than in any other; for here, at a single glance, the eye sweeps over the entire field, readily detecting abrasions or reddened spots upon the epithelium which the finger is incompetent to note.
Finally, I observe, that the frequent self-assumption of the genu-pectoral posture by the patient affords a most potent supplement to the regular treatment in the class of cases under discussion. This may be done at night with much profit, and even at frequent intervals during the day when the symptoms are urgent. The patient should lie in the prone or semi-prone position for some time afterwards, avoiding the erect posture for a few hours. In this manner the weight of the superincumbent viscera is taken off the pessary, if one has been introduced; or if not, much may be accomplished in the way of relief from backache, intra-pelvic pains, cystic or rectal irritation, and other phenomena usually attendant upon these maladies, when it is inconvenient or impossible for the patient to consult the physician with regularity. Furthermore, the frequent self-assumption of this posture establishes the “habit” of replacement of the intra-pelvic organs, and, by unloading the vessels, relieves hyperæmia, congestion, and pelvic blood stasis.
AVELING.— “ The Influence of Posture on Women in Gynecic and Obstetric
Practice." Philadelphia, Lindsay and Blakiston, 1879. BOZEMAN. -"The Mechanism of Retroversion and Prolapsus of the Uterus,"
etc. Transactions of the American Gynecological Society,
Vol. III. 1878. BURRELL.—“On Some of the Uses of the Knees and Elbows Posture."
American Journal of the Medical Sciences. January, 1874,
p. 103. CAMPBELL.—“ Résumé of a Report on Position, Pneumatic Pressure and
Mechanical Appliances in Uterine Displacements." Augusta,
Georgia. 1876. Campbell.—“Pneumatic Self-Replacement of the Gravid and Non-Gravid
Uterus.” Transactions of the American Gynecological Society.
Vol. I. 1876. Hart.—“The Clinical Features, Anatomy, and Uses of the Genu-pectoral
Posture." American Journal of Obstetrics. October, 1881.
Vol. XIV., p. 820. Mundé.—“Treatise on Minor Surgical Gynecology." New York. Wm.
Wood & Co. 1880. MUNDÉ.—“ The Curability of Uterine Displacements." American Journal
of Obstetrics. October, 1881. Vol. XIV., p. 789. MUNDÉ.-" Prolapse of the Ovaries." Transactions American Gynecologi
cal Society. 1879. Vol. IV., p. 164. SIMS.—"Clinical Notes on Uterine Surgery." New York. Wm. Wood &
Co. 1871. SKEENE.—“ The Relation of the Ovaries to the Brain and Nervous System."
American Journal Obstetrics. January, 1881. Vol. XIV., p. 54.
This instrument consists of a tube open at both ends. In one end there is a staff which can be moved in and out of the tube by a button running in a groove. To this staff is fastened a band of steel about a quarter of an inch wide, and hinged in the middle, so that there may be no danger of its breaking as it is being contracted or expanded by the sliding button. Upon the inner side, and just below the superior edge of this band, there are teeth cut in such a manner that they look backward toward the shaft of the instrument and the hand of the operator, and yet so protected that there is no tendency to injure the mucous membrane or other healthy uterine tissue while we are operating. The instrument I show here is only a model. In those which shall hereafter be made the bands will be thicker, so as to give them greater strength; and it will be possible to adjust, by means of a screw, different sizes of saws to the shaft at the operator's pleasure.
This serrated scoop is intended to be used in the removal of sessile and other uterine fibroid tumors. Its advantages over all other instruments devised for the same purpose that I have seen are several. Owing to the possibility of increasing or decreasing its size, we can pass it into the uterus without dilating the os to such a marked degree as is necessary with the ordinary curette, or without slitting the os to the extent
that is also sometimes necessary. It fits tightly to that portion of tissue which we wish to remove, and yet does not tend to injure the adjoining healthy tissue. Again, we can feel with the finger through it just what tissue we are dividing; a thing which it is impossible to do with any spoon curette, except that recently devised by Dr. H. O. Marcy. Finally, after we have detached the new growth, we can grasp it firmly in the teeth of the saw, and withdraw it from the uterine cavity without the introduction of another instrument.
The curette and tourniquet end of the instrument consists of a single steel band which can be expanded or contracted in the same way as the saw by sliding a button in the handle. It is intended, when contracted, to be used in the same manner and for the same purpose as an ordinary curette. When expanded to its full extent, it can be used as an uterine tourniquet, and will be found very convenient in replacing malpositions and displacements of the uterus. The extreme simplicity of the whole instrument increases its practical value, and renders the task of keeping it antiseptically clean an easy one.