A study of two mesial vertical sections of the female pelvis in relation to the normal support of the uterus and prolapsus uteri / by David Berry Hart.

  • Hart, D. Berry (David Berry), 1851-1920.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: A study of two mesial vertical sections of the female pelvis in relation to the normal support of the uterus and prolapsus uteri / by David Berry Hart. Source: Wellcome Collection.

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    wall is forced out equally with the former. When this xectocele is hooked back, the prolapse follows its usual course. Before finally summing up the factors in the production of a prolapsus uteri, we must consider two important cases which throw some light on the whole subject. E. M., set. 19, was admitted to ward XII. M. The points m her case bearing on our present subject were, first, that the peiineum was completely torn just down to the anterior margin oi the anus. The sphincter was only involved to a very small extent, but still a little flatus and faeces passed if she strained violently. More than an inch of the anterior vaginal wall was, of course, exposed un¬ supported. The perineum had been thus torn about eighteen months previously, but as yet no prolapse of vaginal w7all had occurred. Under straining efforts and hooking back of the posterior wall the vaginal wall prolapsed considerably. Now, at first, I felt inclined to think that here was strong proof for the belief that the perineum has nothing to do with pro¬ lapsus uteri. Careful observation of the case, however, revealed the following facts :—Filling up the angular gap left by the perineal tear was an excrescence of mucous membrane, really a small recto- cele. It almost touched the anterior vaginal wall, and pressing firmly against it when enlarged during straining, helped efficiently to bank it up. It was indeed an accidental and by no means inefficient substitute for the perineum. But, further, the patient had a retroflexed and enlarged uterus, which of course made tension on the anterior triangle, and helped to prevent its eveision. These two co-existent lesions explain why this girl had no prolap¬ sus as yet, and show that in other cases careful search should be made for causes preventing it. The second case was one with marked lacerations of the peri¬ neum and no prolapse. A tedious first labour ending in vesico¬ vaginal fistula, and consequent urinary irritation, had, however, so thickened and indurated the vaginal wall as to render its crumpling out at the dilated vaginal orifice impossible. In the last place, we have in almost all cases of prolapsus uteri, a definite mechanism as viewed at the vaginal orifice, viz., descent of anterior vaginal wall, cervix uteri, and posterior wall. Xow, if the uterus be pulled down by a vulsellum, it will be found that the os uteri is at the vaginal orifice before any part of the walls is everted, and that when the os uteri is so placed, v7e have the vaginal walls forming a deep pouch all around. Hauling down the uterus to imitate a prolapsus would really do so if the uterus ever primarily descended—a thing I have never seen. I he true way to imitate prolapsus is to haul or push down the anterior pubic triangle. It is evident that this will be easy in a cadaver where the support of the posterior wall is lost at its lowest part by perineal laceration, and where the anterior triangle has more or less lost its tone. There will be great difficulty