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PROLAPSVS UTERI.
375
In this inserted state of the vagina and prolapsed uterus the os tincæ was, of course, the farthest projecting point. Two incisions were thus made, which, at the os externurm,suddenly approachedeach other. During these incisions a slight haemorrhage occurred about one inch from theireommencement, where a small branch of one of the vaginal arteries happened to run. There w no pain felt till the incision was brought back to the termination of the mucous cohering of the vagina, where it becomes continuous with the skin. The incisions being completed, an inch and a half of the mucous membrane of the vagina was dissected out, and the edges apto the os externum.
PROLAPSVS UTERI. To the Editor
of THE LANCET
SIR:—Having read report of
in the last LLANCET a discussion held respecting the prolapsus uteri, at a meeting of
of Royal Medico-Chirurgical Society,
treatment
the
a
request the favour of
I
little space in your Journal for an accoont of an operation for the cure of this complaint, which I witnessed during my attendance at the Anglesey Lying-in Hospital, Dublin, during the winter of 1834-5. Mr. Caesar Hawkins asked, · Had any member any experience of the operation ?" Though I have not the honour of being a member, I hope the following will not be less welcome. Mrs. -, a woman of muscular and athletic frame, was admitted into the Anglesey Hospital on the 18th of Kovember, 1834. By her own account she lived in capacity of servant, and about three years previous to her admission, while engaged in lifting a heavy tub of clothes, she suddenly felt something give way in the " lower part of her belly ;" at the same time she also felt as if something slipped down into the vagina. After some time she found the uterus had descended below the os externum, in which situation it remained while she continued in the erect posture, but when she lay in the recumbent state it returned to its natural situation, and remained so till the erect posture was again resumed, when it descended. In this state it continued till about ten months previous to her admission, when it remained constantly outside the os a
proximated by four interrupted
sutures.
This being accomplished the uterus was re. turned to its natural state, and halfapint of cold water was thrownn up the rectum, immediately after the operation, in order to present inflammation. She was then put to bed, and strict injunctions given to the nurse to keep her in the recumbent posture, in order to assist as much as possible in accomplishing the intention of the operation. Her bowels were kept gently opened with an aperient electuary. Under this treatment she continued three or four weeks, after which time she was dismisscd perfectly cured. Some time afterwards she met Dr. Ireland, and gratefully expressed herself for what he had done for her. She felt herself perfectly cured of her former unpleasant complaint, and never was better in her life. The simplicity of this operation, in my opinion, recommends it as being much prefcrable to the diminution of the calibre of the vagina by means of caustic applications. Itis not always in the power of the operator to limit, accurding as he wishes, the inttuexternum. ence of the latter remedy, so tbat caustics Ou examination Mr. Hayden and Dr. Ire’ produce inflammation and irritation beyond land found the uterus to project about four the part which we wish to destroy. This inches, enveloped in the inverted vagina ; can be witnessed in issues made with pothat portion of the uterus only which, in the tassa fusa, where an extensive redness and natural position of these organs, is sur- , frequently extensive sloughing supervene rounded by the vagina, was visible, so that on the application of this agent. I have at its appearance, thus prolapsed, resembled a present under my care a case illustrative of penis. A slight ulcer on the mucous lining this. of the vagina, near its union with the uterus, 1 agree with Mr. Hawkins, that " exciwas poulticed, and occasionally touched sion is preferable to the application of with nitrate of silver. Under this treatment caustic." " Dr. Moore considered neither it healed in a few days. operation admissible in the majority of cases. A. the poor woman’s circumstances in Members had assumed that prolapsus of the life rendered it necessary that something de- womb always depended on relaxation of the cisive should be determined on, Mr. Hayden, walls of the vagina." This, to say the least Mr. O’Beirne, and Dr. Ireland concluded of it, is certainty not very complimentary to that Dr. Marshali Hall’s operation for pro- the mentbers ; for I should really think the females lapsus uteri should be performed. The lUan’s experience in the diseases ofcan attriwoman, being placed on a table, with her must be very limited indeed, who sboulders slightly elevated by a pillow, and bute every case of prnlapsed womb to rethe hospital nurse and one or two students laxation of the vaginal parietes ; were such holding her arms, Dr. Ireland performed the the case, prostitutes would be greater sufany other operation, commencing with an incision on ferers from this complaint than the mucous coat of the vagina, at its attach- class of females ; yet such is not found to be ment with the uterus, and continuing it back the fact. Almost every case certainly is pro-
the
376
da4ced
the round and broad would denominate the disease the subject of the womb, together with a re- of my paper "psoriasis inveterata;" this laxed state of the walls of the abdomen, fre- latter disease is not unfrequently concomiquently brought on by want of proper ban- tant with lepra; they may be deemed twin daging during confinement; still this is no diseases, but each distinct of its kind. Psoargument against Dr. Marshall Hall’s ope- riasis is always irregular in shape, not ration. Ithe treatment of severe uterine rounded, nor have the patches the raised haemorrhage we should be seldom success- red edges. There are no depressions in the ful did we omit plugging the vagina, though centre of the patches of psoriasis ; the whole few members, I believe, would attribute the patch is a continuous raised rough surface, intersected with fissures, or cause of the hemorrhage to the egress commonly afforded by this organ. cracks, more or less deep or painful. Lepra, I look on the operation as a salutary in its progress towards cure, gets well from means of removing a very great source of the centre, outwards ; psoriasis, on the conmisery, and as such should seldom hesitate trary, gets well from the edges towards the in perfurming it, provided the patient was centre. I last year had a patient with psoriasis past child-bearing, exceptingthose cases where the female has made up her mind to inveterata of both lower extremities; the become a disciple of Malthus. I remain, disease was continuous to high up on the &c. &c. thighs; there was no part of this affected surface where the healthy skin could be JOHN JOSEPH HELY HELY. seen, as would hare been the case in lepra; Foley-place, May 22, 1839. on the contrary, to use a homely term, the parts seemed as though they had been roughly plastered over with some shining LEPROSY. and whitish-coloured mud. REPLY OF DR. JONATHAN GREEN TO DR. Dr. Hancock says," It was the writers HANCOCK. of the last century who, misunderstanding or disregarding the descriptions of lepra, To the Editor qf THE LANCET. arabum, graccorum, and elephantia, as given SIR :-In your Number of the 4th inst. by Araætens, by Rhazes and others,-it was you did me the favour to insert a paper of those writers, I say (of the last century), mine, headed " Cases of Leprosy," which who led to the chaotic confusion, and the has drawn forth from Dr. Hancock some grossest errors on the subject ; and even at remarks, inserted in your Number of the the present day, the,disease known here, and 18th inst., apparently in confutation of what described by our systematic writers under I had advanced. In hopes of making the the name of leprosy, has, in reality, no affisubject more clear, I beg to be again favour- nity with the genuine lepra, lepra arabum, ed with room for two or three paragraphs. or elephantia of the Greek writers." My paper was coufined exclusively to To this statement I cannot concede, and lepra, the diagnosis of which I briefly gave believe that no such confusion or error is as follows:-,- It is not contagious, nor is it manifest to those persons who duly lend the loathsome disease we are apt to associate their minds to the subject of cutaneous diswith it in our minds; it is never attended eases. The physical signs of no class of with oozing or abundant moist discharges, diseases are more evident, nay palpable, ao common with mauy of the skin diseases. and none more easily to be understood, as Its never-failing characteristics are the cir- far as regards their classification and nomencular form of the spots or patches, the de- clature, as they are now arranged ; and in pressions in the centre of these, the raised achieving this great object, of all names, red edges, and the abundant desquamation foreign or domestic, Willan’s must always of clean, shining, transparent scales, which stand out boldly pre-eminent. With the are continual)) being thrown oir from the moderns the lepra arabum, and the lepra parts aflected." Other diagnostics might græcorum constitute quite a different order, have been added, but these I thought amply far removed from the squamae; the former sufficient. In a chart of the skin diseases, being a disease in which the skin is not published hy me ten years ago, lepra is primarily affected, but as the disease probriefly defined as a "chronic intianiniation ceeds the skin becomes dusky, or olive of the skin, almost always in round patches, ! coloured, and greatly thickened, without surrounded by n reddish prominent circle, ! showing other cuticular disorganisation ; it scattered over the surface, and of which the is the deeper subcutaneous congeries of ves. dPvelopcnent has cot been preceded by vesi- sels, and the whole corion, that are implicles or pustules." These distinctive cha- cated, as has been shown by repeated disracters I beiifved to be familiar with the sections. It may be considered as a peculiar profession, at least so with dermatopatholo- enlargement of certain parts. or limbs, rare this country, but yearly becoming more gists. m hot climates, and, as a type, is I am sorry not to agree with Dr. Ha cock, whose views of lepra soem peculiar, as he almost everyhere as the Barbadoes
by flaccidity of
ligaments
i
in frequeat known
In this inserted state of the vagina and prolapsed uterus the os tincæ was, of course, the farthest projecting point. Two incisions were thus made, which, at the os externurm,suddenly approachedeach other. During these incisions a slight haemorrhage occurred about one inch from theireommencement, where a small branch of one of the vaginal arteries happened to run. There w no pain felt till the incision was brought back to the termination of the mucous cohering of the vagina, where it becomes continuous with the skin. The incisions being completed, an inch and a half of the mucous membrane of the vagina was dissected out, and the edges apto the os externum.
PROLAPSVS UTERI. To the Editor
of THE LANCET
SIR:—Having read report of
in the last LLANCET a discussion held respecting the prolapsus uteri, at a meeting of
of Royal Medico-Chirurgical Society,
treatment
the
a
request the favour of
I
little space in your Journal for an accoont of an operation for the cure of this complaint, which I witnessed during my attendance at the Anglesey Lying-in Hospital, Dublin, during the winter of 1834-5. Mr. Caesar Hawkins asked, · Had any member any experience of the operation ?" Though I have not the honour of being a member, I hope the following will not be less welcome. Mrs. -, a woman of muscular and athletic frame, was admitted into the Anglesey Hospital on the 18th of Kovember, 1834. By her own account she lived in capacity of servant, and about three years previous to her admission, while engaged in lifting a heavy tub of clothes, she suddenly felt something give way in the " lower part of her belly ;" at the same time she also felt as if something slipped down into the vagina. After some time she found the uterus had descended below the os externum, in which situation it remained while she continued in the erect posture, but when she lay in the recumbent state it returned to its natural situation, and remained so till the erect posture was again resumed, when it descended. In this state it continued till about ten months previous to her admission, when it remained constantly outside the os a
proximated by four interrupted
sutures.
This being accomplished the uterus was re. turned to its natural state, and halfapint of cold water was thrownn up the rectum, immediately after the operation, in order to present inflammation. She was then put to bed, and strict injunctions given to the nurse to keep her in the recumbent posture, in order to assist as much as possible in accomplishing the intention of the operation. Her bowels were kept gently opened with an aperient electuary. Under this treatment she continued three or four weeks, after which time she was dismisscd perfectly cured. Some time afterwards she met Dr. Ireland, and gratefully expressed herself for what he had done for her. She felt herself perfectly cured of her former unpleasant complaint, and never was better in her life. The simplicity of this operation, in my opinion, recommends it as being much prefcrable to the diminution of the calibre of the vagina by means of caustic applications. Itis not always in the power of the operator to limit, accurding as he wishes, the inttuexternum. ence of the latter remedy, so tbat caustics Ou examination Mr. Hayden and Dr. Ire’ produce inflammation and irritation beyond land found the uterus to project about four the part which we wish to destroy. This inches, enveloped in the inverted vagina ; can be witnessed in issues made with pothat portion of the uterus only which, in the tassa fusa, where an extensive redness and natural position of these organs, is sur- , frequently extensive sloughing supervene rounded by the vagina, was visible, so that on the application of this agent. I have at its appearance, thus prolapsed, resembled a present under my care a case illustrative of penis. A slight ulcer on the mucous lining this. of the vagina, near its union with the uterus, 1 agree with Mr. Hawkins, that " exciwas poulticed, and occasionally touched sion is preferable to the application of with nitrate of silver. Under this treatment caustic." " Dr. Moore considered neither it healed in a few days. operation admissible in the majority of cases. A. the poor woman’s circumstances in Members had assumed that prolapsus of the life rendered it necessary that something de- womb always depended on relaxation of the cisive should be determined on, Mr. Hayden, walls of the vagina." This, to say the least Mr. O’Beirne, and Dr. Ireland concluded of it, is certainty not very complimentary to that Dr. Marshali Hall’s operation for pro- the mentbers ; for I should really think the females lapsus uteri should be performed. The lUan’s experience in the diseases ofcan attriwoman, being placed on a table, with her must be very limited indeed, who sboulders slightly elevated by a pillow, and bute every case of prnlapsed womb to rethe hospital nurse and one or two students laxation of the vaginal parietes ; were such holding her arms, Dr. Ireland performed the the case, prostitutes would be greater sufany other operation, commencing with an incision on ferers from this complaint than the mucous coat of the vagina, at its attach- class of females ; yet such is not found to be ment with the uterus, and continuing it back the fact. Almost every case certainly is pro-
the
376
da4ced
the round and broad would denominate the disease the subject of the womb, together with a re- of my paper "psoriasis inveterata;" this laxed state of the walls of the abdomen, fre- latter disease is not unfrequently concomiquently brought on by want of proper ban- tant with lepra; they may be deemed twin daging during confinement; still this is no diseases, but each distinct of its kind. Psoargument against Dr. Marshall Hall’s ope- riasis is always irregular in shape, not ration. Ithe treatment of severe uterine rounded, nor have the patches the raised haemorrhage we should be seldom success- red edges. There are no depressions in the ful did we omit plugging the vagina, though centre of the patches of psoriasis ; the whole few members, I believe, would attribute the patch is a continuous raised rough surface, intersected with fissures, or cause of the hemorrhage to the egress commonly afforded by this organ. cracks, more or less deep or painful. Lepra, I look on the operation as a salutary in its progress towards cure, gets well from means of removing a very great source of the centre, outwards ; psoriasis, on the conmisery, and as such should seldom hesitate trary, gets well from the edges towards the in perfurming it, provided the patient was centre. I last year had a patient with psoriasis past child-bearing, exceptingthose cases where the female has made up her mind to inveterata of both lower extremities; the become a disciple of Malthus. I remain, disease was continuous to high up on the &c. &c. thighs; there was no part of this affected surface where the healthy skin could be JOHN JOSEPH HELY HELY. seen, as would hare been the case in lepra; Foley-place, May 22, 1839. on the contrary, to use a homely term, the parts seemed as though they had been roughly plastered over with some shining LEPROSY. and whitish-coloured mud. REPLY OF DR. JONATHAN GREEN TO DR. Dr. Hancock says," It was the writers HANCOCK. of the last century who, misunderstanding or disregarding the descriptions of lepra, To the Editor qf THE LANCET. arabum, graccorum, and elephantia, as given SIR :-In your Number of the 4th inst. by Araætens, by Rhazes and others,-it was you did me the favour to insert a paper of those writers, I say (of the last century), mine, headed " Cases of Leprosy," which who led to the chaotic confusion, and the has drawn forth from Dr. Hancock some grossest errors on the subject ; and even at remarks, inserted in your Number of the the present day, the,disease known here, and 18th inst., apparently in confutation of what described by our systematic writers under I had advanced. In hopes of making the the name of leprosy, has, in reality, no affisubject more clear, I beg to be again favour- nity with the genuine lepra, lepra arabum, ed with room for two or three paragraphs. or elephantia of the Greek writers." My paper was coufined exclusively to To this statement I cannot concede, and lepra, the diagnosis of which I briefly gave believe that no such confusion or error is as follows:-,- It is not contagious, nor is it manifest to those persons who duly lend the loathsome disease we are apt to associate their minds to the subject of cutaneous diswith it in our minds; it is never attended eases. The physical signs of no class of with oozing or abundant moist discharges, diseases are more evident, nay palpable, ao common with mauy of the skin diseases. and none more easily to be understood, as Its never-failing characteristics are the cir- far as regards their classification and nomencular form of the spots or patches, the de- clature, as they are now arranged ; and in pressions in the centre of these, the raised achieving this great object, of all names, red edges, and the abundant desquamation foreign or domestic, Willan’s must always of clean, shining, transparent scales, which stand out boldly pre-eminent. With the are continual)) being thrown oir from the moderns the lepra arabum, and the lepra parts aflected." Other diagnostics might græcorum constitute quite a different order, have been added, but these I thought amply far removed from the squamae; the former sufficient. In a chart of the skin diseases, being a disease in which the skin is not published hy me ten years ago, lepra is primarily affected, but as the disease probriefly defined as a "chronic intianiniation ceeds the skin becomes dusky, or olive of the skin, almost always in round patches, ! coloured, and greatly thickened, without surrounded by n reddish prominent circle, ! showing other cuticular disorganisation ; it scattered over the surface, and of which the is the deeper subcutaneous congeries of ves. dPvelopcnent has cot been preceded by vesi- sels, and the whole corion, that are implicles or pustules." These distinctive cha- cated, as has been shown by repeated disracters I beiifved to be familiar with the sections. It may be considered as a peculiar profession, at least so with dermatopatholo- enlargement of certain parts. or limbs, rare this country, but yearly becoming more gists. m hot climates, and, as a type, is I am sorry not to agree with Dr. Ha cock, whose views of lepra soem peculiar, as he almost everyhere as the Barbadoes
by flaccidity of
ligaments
i
in frequeat known