A clinical history of the medical and surgical diseases of women / by Robert Barnes.
- Robert Barnes
- Date:
- 1874
Licence: Public Domain Mark
Credit: A clinical history of the medical and surgical diseases of women / by Robert Barnes. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
741/842 page 731
![least, the disease will be stayed. And there is little drawback in the shape of danger from the operation to deter from its performance. Where the vaginal-portion is attacked by medullary cancer, whilst in the stage of localization, especially in the mushroom form, the uterus being still movable, amputation should be performed. The fixing of the uterus being due in almost every case to the exten- sion of the disease to the roof of the vagina, the base of the bladder, and the broad ligaments, is evidence that it has passed the boundary where it can be reached by topical remedies. This fixing is also, I think, in many cases evidence that the disease has invaded the lym- phatic vessels and glands, a still further discouragement from resort to severe surgical treatment. When the operation is determined upon, we have to consider the best mode of performing it. If we use the knife or scissors, especial care must be taken to avoid opening the roof of the vagina behind, and per- forating the retro-uterine peritoneal pouch. To obviate this accident, which might be fatal, the vaginal-portion of the uterus must be care- fully isolated from the vagina. Dr. Emmet (Amer. Journ. of Obstet- rics, 1869) recommends before amputating to examine whilst the patient is placed on her knees and elbows. This, by favoring gravitation, enables us to note the exact length of the neck more accurately, since, in the ordinary posture, the neck is always apparently longer from pro- lapse of the uterus. But since it is almost indispensable to the use of the knife or scissors that the whole uterus be brought low down near the vulva, there must always be danger of drawing down the roof of the vagina and the retro- uterine peritoneal pouch with it. And in pursuance of the object to divide the cervix as high as possible in order to get into sound tissue, the danger of opening this pouch is serious. It constitutes an important objection to this mode of operating. The objection applies also to the chain-ecraseur, which is very apt to drag in the peritoneal pouch. It applies in a minor degree to the single-wire ecraseur. But the galvano- caustic wire is almost wholly free from this objection. The knife and scissors, and the single wire also, entail serious danger from hemorrhage. To arrest this it may be possible to transfix the stump with a curved needle carrying a silver wire. But the best way is to use the actual cautery. Copper or iron cauteries should always be ready when this operation is undertaken. The Operation of Amputating the Vaginal-portion of the Uterus affected with Malignant Disease,—By far the best plan is to use the galvano- caustic wire. The patient is placed under chloroform in lithotomy position. (See p. 539.) Sims's speculum is introduced to keep well back the perineum and posterior wall of the vagina. An assistant on either side holds open the lateral and anterior walls of the vagina by small retractors. The diseased mass thus well exposed is seized as far hack' as possible with a vulsellum, taking care not to tear through the fragile structure. The mass thus brought forward near the vulva partly by gentle traction, hut more by the firm pressure of an assistant's hand upon the fundus uteri applied above the symphysis pubis, is then encircled by the cold platinum-wire loo]) passed over the vulsellum.](https://iiif.wellcomecollection.org/image/b21039884_0741.jp2/full/800%2C/0/default.jpg)
