On the constitutional character and treatment of the diseases of women connected with chronic inflammation of the uterus / by Thomas More Madden.

  • Madden, Thomas More, 1838-1902.
Date:
1873
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Licence: Public Domain Mark

Credit: On the constitutional character and treatment of the diseases of women connected with chronic inflammation of the uterus / by Thomas More Madden. 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.

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    that the view it affords of the seat of the disease is less satisfactory than that given by the latter instrument. The first objection is, I think, a serious one. For though we must all agree with Dr. Sims that delicacy and propriety, as well as the safety of the surgeon’s character, require the presence of a third person whenever it can possibly be obtained on such occasions, still there are many cases in which no one qualified to render the surgeon the requisite assistance is at hand. With regard to the second objection, all I can say is that in this country at least very few decent women would, without some extreme necessity, which, in my opinion, does not exist in the complaints now under consideration, submit themselves to a vaginal examination conducted in the manner described by Dr. Sims in his original directions for using the “ duck-bill speculum.” Even the greatly modified method of using this instrument now recommended by Dr. Sims in his valuable work on uterine surgery,a is, according to my experience, neither neces- sary nor expedient in these cases. The employment of the tenaculum hooked into the anterior lip of the os uteri, as directed by this eminent American surgeon, although now very generally practised, is, like several other points in modern gynaecological practice— “. . . a custom More honoured in the breach than the observance.” It is true that the cervix uteri apparently possesses very little sensi- bility, and sometimes bears very rough handling, without any obvious ill effects. Yet it surely needs no argument to prove that it is not desirable to drag down the uterus towards the vulva by means of a steel hook fixed in an inflamed or ulcerated cervix. In other uterine diseases I have indeed often availed myself with advantage of this method of bringing the os uteri into view or the uterus within my reach in cases that could not have been treated otherwise. But, on the other hand, I have seen very unpleasant consequences from the indiscriminate practice of harpooning the cervix with a tenaculum for the purpose of remedying the surgeon’s want of dexterity in bringing the os tine® into view with the speculum. Dr. Byrne of Brooklyn has recently published in the American Journal of Obstetrics a description of a new self-retaining speculum, or rather perinasum depressor, combining the advantages of the “duck-bill” and cylindrical specula, which, as far as can be judged from the inventor’s account, promises to be a valuable instrument. For all ordinary diagnostic purposes I have found the ordinary glass- reflecting or Fergusson's speculum sufficient, and either that or Dr. Graily Hewitt’s excellent bivalve speculumb was employed in at least nine-tenths of all the cases of ulceration that came under my observation. * Clinical Notes on Uterine Surgery. By J. Marion Sims, M.D., p. 23. Lond. 1866. b The Diagnosis and Treatment of Diseases of Women. Second edition. Lond. 1871.