Diseases of women and abdominal surgery . lientele, rarely occurring in private practice, byreason of the fact that the women who constitute our privatepatients are better cared for, are allowed to rest longer after theirconfinements, and engage in less heavy occupations than thosepoor sufferers who have to seek relief at the hospital. Thiscondition is one in which the perinteum is stretched by repeatedlabours, while the uterine ligaments are not sufficiently powerfulto sustain the heavy sub-involveduterus characteristic of the hospitalpatient. A complication is alsodue to the careless habits
Diseases of women and abdominal surgery . lientele, rarely occurring in private practice, byreason of the fact that the women who constitute our privatepatients are better cared for, are allowed to rest longer after theirconfinements, and engage in less heavy occupations than thosepoor sufferers who have to seek relief at the hospital. Thiscondition is one in which the perinteum is stretched by repeatedlabours, while the uterine ligaments are not sufficiently powerfulto sustain the heavy sub-involveduterus characteristic of the hospitalpatient. A complication is alsodue to the careless habits oftliese women in allowing over-distension of both rectum andbladder, so that the disabledperinaeum will allow a protrusionof uterus or of rectum (recto-vaginocele) or of bladder (vesico-vaginocele) or of all three (com-plete protrusions); conditionswhich I shall speak of more indetail afterwards. A great manypessaries have been devised forthese complaints, by far the bestof wliichisSimpsons shelf pessary;but I have given them all up for. PERINEUM. 67 the reason that the Muineii w ill not attend to them, coming backyears afterwards, having worn the pessary all tlie time, with arectal or vesical fistula—or worse still, tliey go to other surgeons toair their troubles, and similarly the patients of otlier surgeons havecome to me. Thereftire 1 will have no more to do with ])essariesfor the relief of i)rutrusions in hospital practice. 1 perform in suchcases a simple operation which 1 term extension of the periuieum,and I use it for protrusion of the uterus, or rectum, or bladder. For protrusion of the uterus I operate from behind forwards,truly extending the periuieum. Por protrusion of the bladder Ioperate from before backwards, making, as it were, a second andinverted perina3um. But the operations are practically the make an artificial slielf on which the previously protrudedorgans rest and by which they are retained completely. Of theo])eration for protruded uterus I
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Keywords: ., bookauthortait, bookcentury1800, bookdecade1880, booksubjectwomen
