Prolapsus Uteri. ARTICLE LXXIX. Its Surgical Treatment, by E. F. HOFMANN, M. D., of In addressing the medical profession with regard to the use of any form of mechanical support for the relief of prolapsus uteri, I am well aware that there is little confidence in the forms of pessaries in general use at the present time; and I have arrived at the conclusion that it is based on the utter inutility of the instruments hitherto employed. Practitioners have been obliged to avail themselves of various forms of pessaries which, on account of improper construction, have afforded so little relief, or even have proved positively injurious, that many eminent men in the profession have long discontinued the use of all mechanical appliances. Having given especial attention to the treatment of diseases peculiar to females, and having made use of pessaries of every conceivable shape to be obtained in this country, and in Europe, I found on examining their various forms of construction, that they bore no natural relation to the parts with which they wer e to be placed in contact; they were not in anatomical harmony with the pelvic organs. The most pernicious of all, proved to be the so-called "IntraUterine Stem Pessary." This instrument causes congestion, inflammation, and induration of the uterus, often resulting in frightful ulceration. Other forms of pessaries, by their improper construction, cause ante-version, retro-version, retro-flexion or anteflexion. Still other varieties are only kept in place by their immense size, greatly distending the soft parts, thereby increasing rather than diminishing the displacement of the uterus. The form known as the letter "S" pessary, and those which are constructed of wire, or any hard substance, are retained by constant pressure on two opposite points, which, if uninterrupted, necessarily interferes with proper nutrition of the parts, and frequently resulting in deep ulceration. The instrument I have invented and offer as superior to all others hitherto ever prepared is called the "Anatomical Pelvic Pessary." The name is selected on account of its close resemblance to the form of the pelvis. It was first described by Professor T. G. Thomas in his admirable work on "Diseases of Women," after he had subjected it to a thorough test upon a number of his patients. The pessary contracts downwards all around. It has an opening in the centre large enough to receive the entire neck of the uterus, without undue pressure upon any part of it. The posterior surface, being concave, protects the rectum; the anterior concavity prevents undue pressure on the neck of the bladder, while the elevation on the posterior superior surface is adapted to the concavity of the superior surface of the vagina or posterior cul de sac. There are two transverse grooves on the superior surface of the instrument, one on each side, in which the broad ligaments rest and enable the pessary to rise a little higher up than without them. The diameter is longer transversely than anteroposteriorly. The neck and nearly half the body of the uterus occupies the central opening. The contraction of the soft parts acting on the tapering inferior surface of the instrument keep it in its place; and, of necessity, holds the uterus in its natural and proper position. On account of the soft and yielding substance of which the instrument is constructed, and on account of its perfect anatomical harmony with the parts with which it is placed in contact, the superior extremity of the vagina resting on the superior surface of the instrument and in close contact with its whole surface, it is, in a slight degree, at least kept in position by suction. This form of pessary relieves nearly all the displacements to which the uterus is liable; prolapsus, partial and complete; ante and retro-version; retro-flexion and ante-flexion, and relieving th pain attendant on obstructive dysmenorrhoea. When assisted by other appropriate remedies, this instrument has been eminently successful in the treatment of sterility, a condition of the system frequently resulting from uterine displacement. The pessary of the smallest size, number 00, is so constructed as to facilitate the application of remedial agents to the surface of the tinca. It consists of a sac, its inferior surface being closed by a thin rubber covering. Into the pouch thus formed, ointment, cerates, or liquid applications may be placed. When the latter are to be used, the instrument should be placed in its proper position, and the lotion introduced by means of a syringe having the point bent at an acute angle. To make applications in this manner, the use of the speculum is not necessary. By means of this instrument, the treatment of ulceration and chronic inflammation of the tinc can be treated locally, without injury to the adjacent tissue, and more effectually than by any other method. The instrument is made of soft, elastic rubber; it is hollow, and inflated with air. The material of which it is composed does not contain either zinc or lead, so commonly used in the manufacture of other rubber articles. Soap is a better lubricator than oil; the latter is injurious to india-rubber. The instrument may be cleansed by placing it a short time in a solution of carbolic acid, ten or twelve drops to the ounce of water. At some future time I may prepare a short article setting forth my views and results of my experience in the treatment of uterine displacements and sterility. Six sizes or kinds of the pessary are manufactured: 00, two inches in the transverse diameter, with covering over the lower opening; 0, two inches in diameter; 1, two and a quarter inches; 2, two and a half inches; 3, two and three-quarters of an inch; and 4, three inches in diameter, transversely. ARTICLE LXXX. Sixteenth Annual Report of the Directors of the New York Ophthalmic Hospital, for the year 1867. By H. D. PAINE, M. D., New York. The Hospital is located at 387 Fourth Avenue, corner 28th Street, New York. It was incorporated April 21st, 1852. The Hospital is open for the reception of patients every day at 2 o'clock, Sundays excepted. |