ARTICLE XVI.

Prolapsus Uteri. Its Surgical Treatment, with a Description of a New Uterine Supporter. By E. J. FRASER, M. D., Erie, Pa.

In the medical or surgical treatment of any malady, a correct knowledge of the anatomical construction, physiological action and pathological condition of the organs or parts involved is indispensable to the successful treatment of the same. If such is true as a general rule, it is eminently so in regard to prolapsus uteri, and diseases of the female reproductive system.

The uterus or womb of the human female is about three inches long, two broad at the fundus, one in diameter at the neck, and is flattened from before backwards. It is situated within the cavity of the pelvis, between the rectum and the bladder, and is suspended and kept in its place principally by the broad and round ligaments. Partial support is afforded by the walls of the vagina and the soft parts surrounding the same. When in its natural position, the lower portion or the mouth is distant about four inches above the vulva or orifice of the vagina, while the whole organ is partly below and in front of the sacrum, the fundus at the same time being on a line about two inches below the sacrovertebral promontory. About half of the body of the organ lies beneath the arch formed by the curve of the sacrum, for it will be observed that the sacrum turns abruptly backwards from its point of union with the vertebral column, and then curves downwards. The peculiar manner in which it is suspended within the pelvis, has given it the appellation of the "floating organ.'

The womb is subject to various derangements, one of the most common of which is its descent within the pelvic cavity. Such a condition could be effected only by the lengthening of the suspensory ligaments. This may be the result of immediate violence, or else of relaxation from debility. Whatever the cause may be, the condition is one of dislocation, and is attended with pain and suffering equally as distressing as that produced by the dislocation of an arm or limb.

In regard to treatment, every surgeon knows that the only successful method of treating a dislocated joint is to reduce the [Senate, No. 77.]

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dislocation and apply a retaining apparatus. Analogy and experience teach that this is precisely the case in dislocation of the womb. It needs to be replaced in its proper position and kept there till the ligaments have regained their proper tone and shape, when they will again perform their proper functions and keep the womb in its proper place. Various forms of apparatus have been devised and used for that purpose, comprising rings, cups, globes, sponges, horseshoe, letter "S," and inflated pessaries, and the socalled abdominal supporters. The globes, sponges, some forms of rings, and the inflated pessaries, distend the vaginal canal, and crowd the womb upward, and as they have no receptacle for its neck, often flex it in the line of its axis. When they are removed, the vacuum within the distended vagina presents an inviting location for the uterus to occupy.

All forms of rings and cups give a very uncertain support, and do not even attempt to regulate the projection or line of axis of the organ, and at the same time preserve its natural shape. But the most unscientific and positively injurious apparatus known is the so-called abdominal supporter, which consists of a pad over the lower portion of the lumbar region, another over the hypogastric region, and the two made to approach each other forcibly by means of steel springs around the body. Such pressure would of course force the womb backwards under the projecting sacrum, and of course downwards in a line of the vaginal canal. These supporters sometimes have a supporting cup and wire introduced into the vagina, and the action and reaction caused by such an apparatus cannot fail to produce flexion of the womb in the line of its axis.

All forms of apparatus heretofore used have proved in all cases so nearly useless, and in many so positively injurious, that very many intelligent physicians have discarded their use altogether.

The royal road to success, however, in this as in all other pursuits, has not been on a direct line "across corners," but has taken "the longest way around." The author of this paper, however, after trying all the various kinds with the usual failure, attempted the construction of a uterine supporter on scientific principles, and after a series of repeated trials, developed the form herewith illustrated. The neck of the uterus is embraced within, the mouth passes through, and the body rests upon, the bell-shaped ring-the cul de sac easily yielding to admit of such a situation. The ring is securely held at its proper angle and

elevation by the bows, the basket-shaped base of which are in turn supported by the perinæum and muscles of the vulva. Whe inserted, it is so imbedded in the soft parts of the vagina, that turning or displacement is utterly impossible. The functions of the urethra and rectum are not interfered with, neither is there any obstruction to the passage and free exit of secretions from the uterus. It is entirely concealed, and although very securely held in place, produces no undue distention of the vaginal walls. It is constructed of metal, the coarsest of which that comes in contact with the parts is pure silver. It can be worn any length of time without irritation, and be removed when the organs have regained their normal situation.

It is believed that in this supporter a new and very useful instrument is placed in the hands of the physician and surgeon, by the aid of which he can relieve an untold amount of human suffering.