Identifier: minorsurgicalgyn1880mund (find matches)
Title: Minor surgical gynecology : a manual of uterine diagnosis and the lesser technicalities of gynecological practice : for the use of the advanced student and general practitioner
Year: 1880 (1880s)
Authors: Mundé, Paul F. (Paul Fortunatus), 1846-1902
Subjects: Generative organs, Female Gynecologic Surgical Procedures Gynecology Gynecology
Publisher: New York : W. Wood & company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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r the replacement of a retroverted uterus, and its de-velopment into a systematic method, with the assistance of pneumatic in-tra-vaginal pressure, is due mainly to the efforts of Dr. Henry F. Camp-bell, of Augusta, Ga. Others independently hit upon the same principle,as Solger, of Berlin, and myself (who accidentally replaced a retrovertedgravid uterus, which had resisted all the methods above mentioned, by ele-vating the perineum with Sims speculum in the knee-chest position, andthus expanding the vagina with air), but to Campbell is due the credit ofhaving thoroughly worked up the subject. His explanation of the methodof replacement is illustrated by Figs. 213 and 214 taken from his article.In Fig. 213 the uterus is retroverted, and the intestines crowded down intothe pelvic cavity, leaving a free space between the upper border of the intes-tines and the diaphragm. This vacuum is, of course, imaginary and existsonly momentarily while the instantaneous change represented in Fig. 214
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Pig. 214.—Replacement of retroverted uterus iu knee-chest position and by air-pressure. (Campbell.) takes place. Here we see the intestines all prolapsed toward the dia-phragm, the vagina dilated (I have added a Sims speculum to show theelevation of the perineum) and the uterus replaced, that is, anteverted.The forces which achieved this result are 1, suspension of intra-abdomi-nal pressure, and consequent traction on the pelvic viscera, vis a /route,and 2, intravaginal atmospheric pressure, vis a tergo. The former actionis a suction force on the pelvic organs, which is compensated for by therush of air into the vagina. The position alone might effect the replace-ment, but it is materially aided by the air-pressure, which acts in thesame manner as the fingers in lifting up the fundus. That all retro-displacements can be replaced in this manner, as Camp-bell claims, has certainly not been my experience. I have found numer-ous instances in which the fundus remained wedged into the sac

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