PRESIDENT AND EMERITUS PROFESSOR OF OBSTETRICS, AND DISEASES OF WOMEN AND
CHILDREN, IN THE BELLEVUE HOSPITAL MEDICAL COLLEGE; ATTENDING

PHYSICIAN TO BELLEVUE HOSPITAL, THE CHARITY HOSPITAL, THE

INFANTS' HOSPITAL; CONSULTING PHYSICIAN ΤΟ THE

STATE WOMAN'S HOSPITAL; VICE-PRESIDENT NEW

YORK ACADEMY OF MEDICINE, ETC., ETC.

E PIBKYBA

N410 T24 1869

N AMPUTATION

OF

THE CERVIX

UTERI

"PROLAPSUS uteri " and "procidentia uteri " are the terms generally employed to indicate the descent of the uterus from ts normal position in the pelvis.

This displacement is ordinarily divided into three degrees: 1. A settling down of the uterus, as if from relaxation. In this case the uterus descends toward the lower part of the pelvis, shortening the vagina in proportion as it fills the upper portion of its cavity, which it distends and pushes before it.

2. The same prolapsus, or descent, is characterized by the presence of the os tincæ at the vulva. The uterus rests on the internal surface of the perinæum, and fills the vagina, the upper half of which becomes folded within itself, like the finger of a glove, with its top turned inward (Gardien). The uterus thus situated takes the direction of the axis of the outlet of the pelvis, that is, of the vagina.

3. In complete prolapsus, or procidentia, the womb has escaped from the vulva, or os externum. It has now passed the inferior strait, or hangs between the thighs, covered by the vagina. The vagina is invaginated, or turned wholly inside out, and embraces not merely the uterus, and its appendages, but also the bladder, part of the rectum, and some

portion of the intestine (Kerkringius, Dugés, Saviard). It may contain not merely the uterus, but frequently the ovaries, with large portions of the round and broad ligaments, portions of the small intestines, the bladder, and rectum (Hodge).

It is upon this last, or third degree, I propose offering some practical observations in the following paper:

The preceding divisions, and the opinions relating to them, which I have given, are from the highest obstetrical authorities, both abroad and in our own country. They have been the recognized views of the medical profession for a very long period. Their correctness, however, has been called in question within the last few (ten) years by M. Huguier.'

An elaborate memoir was afterward presented by M. Huguier to the Académie de Médecine, in Paris, March 8, 1859, "sur les allongements hypertrophiques du col de l'utérus, dans les affections designées sur les noms de descente de précipitation de cet organe, et sur leur traitement, par la résection en l'amputation de la totalité du col suivant la variété de la maladie."

In this memoir M. Huguier maintains that the ordinarilyreceived opinion is erroneous, and denies emphatically that the appearance of the os uteri at the vulva, or of a greater or less portion of the uterus itself beyond the external organs of generation, is the result of a displacement of the organ, or a general lowering, or that it is a true and complete prolapsus en totalité. He holds that this can be shown to depend on inaccurate observations. He contends that when the uterus appears externally, and even when the vagina is completely inverted, and the uterus appears to be entirely prolapsed between the thighs, this condition is not due to the fact that the organ has been generally lower in the level, and had completely left the pelvic cavity, but rather to the partial or general hypertrophic elongation of the supra-vaginal portion of the cervix. The best proof he alleges that can be given of this is, that in almost all the cases the fundus of the uterus continues habitually in its normal situation, sometimes a little higher, sometimes a little