Page:Clinical Lectures on the Diseases of Women.djvu/222

212 Among such is the disc and stem pessary, and the Zwanck instrument.

Another method, and one especially applicable to unmarried women, or after the child-bearing period, is to nearly close the orifice through which the womb comes out, not strictly to restore the perineum, for it may be anatomically entire, but what is termed episioraphy. When the operation is finished, the mouth of the vagina is contracted, and there is no great gaping orifice. So long as it keeps like this, the womb cannot come out. And this operation cures a great many cases.

I may mention the case of a nurse in the Royal Infirmary of Edinburgh. I need hardly say that few occupations could be worse for procidentia than that of a hospital nurse. The operation of episioraphy was performed upon her, she was cured, and she retained her situation for some years; she then married a second time, and had two children. The child-bearing destroyed all the renewed perineum; the womb came down again. She once more became a widow; I operated again, and she is at the present time a nurse in the Royal Infirmary, and has been so for many years, without any procidentia whatever.

A third method is the T bandage with perineal pad, which is very valuable in a case of this kind as an adjuvant. Suppose that the door behind me is open, and I stand in the doorway. I cannot prevent you from crowding out; you will push by me on one side or the other. So it is with the gaping orifice of the vagina, the T bandage will not prevent the womb from forcing its way out on one or other side of it. Episioraphy is equivalent to shutting the door. Then the T bandage acts like the hand placed against the other side of the door, it exerts a force which counteracts the pressure from within, and forbids passage to anything.

Difficulty in curing, or keeping replaced, varies with variations of one condition—namely, the amount of downward pressure of the displaced parts that has to be overcome.