Observations on some forms of sterility and on placenta praevia in first labours : with illustrative cases / by Alexander Russell Simpson.

  • Simpson, A. R. (Alexander Russell), 1835-1916.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: Observations on some forms of sterility and on placenta praevia in first labours : with illustrative cases / by Alexander Russell Simpson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    11/16 (page 11)
    case as this which we are now considering will be apt to suspect that these review-writers are more skilful in handling the critic’s pen than the practitioner’s probe. I have seen many such cases. Most frequently, as Dr Marion Sims1 has shown in his interesting statistics, the backward displacements are prominent in cases of acquired sterility—in cases, i.e., of women who have given birth to one or more children, and have ceased to conceive before their usual period of reproduction was run out. In the present instance and in other patients whom I have seen, however, the displace- ment had come about antecedently to marriage, and proved a bar to conception. This it may do either by marring the function of the uterus and Fallopian tubes as the canals for the upward transit of the spermatozoa, or by impairing the function of the uterus as the organ for the reception and lodgment of the fertilized ovum. At whatever time the displacement has been produced, and in what- ever way it interferes with reproduction, it is of the greatest moment to the barren woman that it should be recognised and rectified. 1st, Recognition.—It may be recognised by the finger introduced into the vagina, and still more definitely when two fingers can be used simultaneously for exploration. The detection of it may be aided by dragging down the cervix with a volsellum. Greater certainty still can be attained by the combined external and internal examination, by which means the great proportion of cases can be clearly diagnosed. There remains but the employment of the sound, which may be used with due precautions to give absolute certainty of diagnosis in any case, and which must in some be used as the only sure means of detecting the displacement. 2d, Reposition.—The sound need not by any means be used for the recognition of every case. Many are clearly recognisable without it. But there are few cases where the reposition is not best effected by means of it. For when the condition has .been recognised, it becomes our plain duty to attempt to rectify it. We are some- times bidden look upon the endometritis or general congestion that almost invariably accompany retroflexion as the essential mis- chief in the patient requiring special treatment. We do well in many instances to attend to this injunction, but certainly not in every case of retroflexion. According to my experience, the converse more frequently holds good—that if you straighten the uterus, and keep it straight, the congestion disappears, and of this our patient furnishes an illustration. Happily we do not need to follow theorists on either side. But, as a rule, whatever may be done, the uterus must be replaced. The reposition may be effected in various ways. We may do it by internal manipula- tion alone in some rare cases—more particularly if, at the same time, the patient be placed prone, or the cervix be dragged down with a volsellum. Better still, in a greater variety of cases it may be brought about by combined internal and external manipu- 1 Uterine Surgery, p. 237.