Outlines of the diseases of women / by John Phillips.

  • Phillips, John.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Outlines of the diseases of women / by John Phillips. Source: Wellcome Collection.

    170/332 (page 150)
    The bulb of the instrument may ulcerate through the uterine wall, a large arterial trunk, or lead to sepsis. Displacements can be relieved by pessaries or artificial supports, especially if there is an incarcerated fundus to deal with or a slight tendency to descent: always when examining a patient tell her to strain hard or bear down, the uterus always descends a certain amount. Displacements requiring treatment— (1) Retroflexion with incarceration; (2) Retroflexion with slight prolapse; (3) Anteversion with slight prolapse of anterior vaginal wall. For the two former, (1) and (2), the watch-spring ring pessary or Hodge's lever pessary is applicable: the former takes its support from the sides of the vaginal wall, it is pinched between the finger and thumb and inserted into the vulva; as it expands in the vagina it is pushed up to the roof and so placed that the cervix hangs through its centre; benefit is obtained by the relief to the stretched ligaments and the consequent passive congestion (Fig. 68). If the perineum is lacerated or the vagina more dilated below than above, a Hodge's pessary cannot be retained and we must resort to a ring pessary (Fig. 68) The shape of a Hodge's pessary is best indicated by the two Figs. (86, a, b): in section it has an S-shaped curve. It is composed of either malleable metal, celluloid, vulcanite, or watch- spring covered with india-rubber tubing: the two former can be moulded by the hand to fit the vagina, and several sizes should be ready in case of need. How to Insert a Hodge's Pessary.—The woman should be in the left lateral position: replace the uterus by means of the sound, take the instrument, as depicted, in the right hand, hook the left forefinger over the perineum: then, remembering that the vulval slit \8 antero-posterior and that of the vagina transverse, commence by pushing the broader end into the vulva, avoiding the sensitive ure- thral region (Fig. 86, a); when the pessary is well past the vulval slit, rotate it on its long axis half a circle, press the forefinger against the upper bar and carry it backwards and upwards into the posterior cul-de-sac (Fig. 86, b); the pessary should thus lie with its superior concavity upwards and forwards, the inferior downwards and backwards, and is grasped by the vaginal walls and retained; the lower end of the instrument should be in apposition with the anterior vaginal wall. On straining, the patient will push the instrument clown, but it will return to its place on cessation of the effort. She should walk about for ten minutes to ascertain if it is comfortable: if on examination it is still in its place, the patient must be told she is wearing an instrument shown how to