DESCRIPTION 
OF A 
NEW HYSTEROTOME 
FOR THE 
CURE OF DYSMENORRHCEA. 
INVENTED BY 
Dr. 0. A. WHITE, 
Of Charleston, S. C. 
[From Charleston Med. Jour. & Rev./ ni. xir. -Vo. I 
CHARLESTON, S. C. 
JAMES AND WILLIAMS, PRINTERS, 
16 STATE-STREET. 
1859. A NEW HYSTEROTOME. 
Dysmenorrhcea is certainly one of the most painful and 
intractable disorders we can be called upon to treat. It is 
of very frequent occurrence, and is the fruitful source of 
much ill health to females. Commencing, as it has often 
been known to do, even with menstrual life, it may proceed 
unchecked throughout successive years, and yield at last 
only to time and the natural cessation of the discharge. If 
unrelieved, a trifling case is liable to become worse and of 
longer duration, until finally, the afflicted patient may be 
only beginning to recover from the shock of one period 
when the dreaded approach of the next is near at hand. It 
is, therefore, not at all improbable that many unfortunate 
women have fallen victims to consumption and other terrible 
maladies, in consequence of these periodical sufferings. 
Under such circumstances, the attention of accoucheurs 
must ever have been directed to its relief. And such, 
indeed, has been the case, though it is mortifying to reflect 
that until a comparatively recent date the blindest empiri- 
cism appeared to direct the treatment. Incorrect views 
respecting its pathology inevitably led the way to notable 
errors in practice, and the wretched applicant for relief was 
too often subjected to struggle not only with the original 
malady itself, but also against the evil effects of injudicious 
means used to remove it. Thus, at one time, obstetricians 
erroneously attributed all the phenomena of this disease to 
plethora, when cups and lancets were indiscriminately 
applied. At another, debility was the prevailing doctrine, 
and tonics became the fashion. At another, spasm was 
obscurely hinted at as the cause, and opium was the only 
specific. At a still later period we hear of nothing but its 
nervous and neuralgic origin; this was the day of active 
temporising,-main reliance being placed upon inunctions 
with belladonna, acconite, and the like; whilst, behold, at 2 
another, the very identity of the disease was called in ques- 
tion, and ovarian irritation and inflammation imputed the 
source and origin of all the manifold suffering that was 
certainly uterine in its seat. 
Such were many of the vague notions which prevailed 
respecting dysmenorrhoea, anterior to the year 1823. About 
this period Dr. Mackintosh, of Edinburgh, first suggested 
the employment of mechanical means for its relief. Being 
led to investigate this subject by accident, he forthwith 
commenced a series of examinations with experiments, which 
resulted in convincing him that preternatural narrowing of 
the uterine canal was most commonly concerned in the 
production of this complaint. This point being established, 
he next proceeds to account for the alarming symptoms so 
frequently met with, in the following manner: "The men- 
strual discharge, after it is secreted in the uterus, cannot 
readily escape, in consequence of the small size of its orifice; 
distension of the organ is the result, which, by exciting the 
contraction of its fibres, produces uneasiness and pain in the 
pelvic region. When the os uteri*is very small and the 
secretion viscid, or mixed with coagulated blood, shreds of 
membrane, or organized masses, then the distension becomes 
more considerable, and stronger contractions are excited. 
Sometimes the action of the abdominal muscles is called 
into play, and bearing down pains are produced, resembling 
in every particular the pains of labour, and continue until 
the expulsion takes place." 
These observations, originally entertained and expressed 
so many years ago by Dr. Mackintosh, have since become 
generally adopted; and though improvements in the man- 
agement of these cases are still being made, no one can fail 
to observe that the doctrines promulgated by that illustrious 
practitioner continue to influence surgical opinions and 
practice even to the present day. 
Dysmenorrhoea, therefore, being proved to result most 
commonly from mechanical causes, surgical remedies for its 
control have largely superseded the vaunted resources 
of the pharmacopoea. But though surgical appliances 3 
are oftenest available in the management of this disease, 
we must not lose sight of the fact that there are also 
a certain proportion of cases which require constitu- 
tional measures alone for their cure. Let me not, therefore, 
be thought to accord to surgical interference too great 
supremacy, experience having long since assured me that by 
far the largest number are amenable only to a careful and 
judicious institution of both plans of treatment combined. 
If, therefore, we adopt one of these modes of relief, and 
attempt to practice it to the exclusion of the other, we shall 
too often be baffled in our best directed efforts, and find the 
disorder liable to return, even after its apparent removal. 
The method advocated by Dr. Mackintosh consists, as will 
be remembered, of careful and repeated dilatations of the 
os and cervix uteri, with bougies of various sizes. But the 
same evil consequences which often eventuate during 
the management of ordinary urethral stricture, by dilatation, 
were so liable to arise during this course of treatment here, 
that surgeons were soon compelled to abandon this pro- 
ceedure and look to measures more expeditious, and against 
which no such objections could be alledged. 
Accordingly, about twenty years after, Prof. Simpson 
announced to the profession another mode of treating this 
obstinate complaint, by an experiment at once novel and 
brilliant. This was by incisions skillfully made within the 
cervix uteri with appropriate instruments, and keeping the 
parts afterwards dilated with sponge tents until the cure 
was complete- 
In behalf of this safe and simple operation it is contended 
that it at once places the parts in somewhat the same condi- 
tion as subsequent to parturition or a miscarriage. For it 
is a notable fact that many cases of otherwise intractable 
dysmenorrhoea have been known to abate or cease altogether 
after one or other of these occurrences have transpired. 
As to the efficacy of this mode of operating, it would be 
needless here to recount all the high testimony recently 
added in its favor. Suffice it to remark the practice has 4 
since been adopted by many of the most eminent accoucheurs 
and surgeons in this country and elsewhere. 
Promising such certain and expeditious relief as this pro- 
cedure certainly does, the facility with 
which the several steps of the operation may 
be performed cannot fail to interest surgeons. 
Already, therefore, have instruments of dif- 
ferent construction been suggested, each 
having in view that important design. That 
invented by Prof. Simpson has, thus far, very 
justly commanded the greatest favor. This, 
it will be remarked, however, is but a modifi- 
cation of the Lithotome Cacht, which, though 
a contribution of considerable value in its 
proper place, to the armamenta of Surgery, 
is certainly liable here to objections which 
readily suggest themselves to all who attempt 
its use. 
Having been compelled, upon several occa- 
sions, to resort to the practice and the instru- 
ment of this eminent master, for the relief of 
obstructive dysmenorrhoea, the peculiar dan- 
gers which embarrass its use compelled me 
to lay it aside and employ one invented by 
myself, of the following description. 
Annexed is an engraving, which, though 
considerably reduced from the original, will 
assist, I hope, in giving an adequate idea of 
this instrument. It consists, as will be seen, 
of a long and delicate staff or stem affixed to 
a handle of unusual form. The staff is about 
the calibre, and has somewhat the same curve 
as a No. 3 small catheter. It is full nine 
inches in length, and is so plainly notched 
and numbered off upon its posterior surface, 
from the point to the handle, that these 
measurements may easily be distinguished 
by the touch alone. 
Fig. 1. 5 
At a moderate distance from the point of the instrument 
may be noticed two small blades, jutting out from the staff 
on either side. Each of these blades is capable of being 
thrust out about a quarter of an inch, or concealed by being 
withdrawn again within its sheath in the circumference of 
the staff, by means of a certain manipulation at the handle, 
which I shall take occasion presently to describe. 
The standard depth of the womb from the os to the fundus 
uteri has already been ascertained to be just two inches and 
a half. To render, therefore, the application of this instru- 
ment safe, and in order to bring its utility within the range 
of possible cases of even smaller uterine dimensions, a point 
about an inch and a half from the apex of the stem has been 
selected, from which the knives are made to protude when 
needed. 
The projection and closure of these blades is effected with 
great facility, by means of a female screw, (a) which plays 
upon a thread (b) situated at the very butt of the handle. 
This screw is hexagonal in shape, each side of which is made 
to bear a number ranging from one to six. The instrument 
being closed, No. 1 corresponds exactly to the convex surface 
of the handle, but progressively, as the succeeding numbers 
are brought upwards, by turning the screw, the blades are 
forced out to the extent desired; No. 6, of course, denoting 
the maximum. The value of this little contrivance will be 
obvious, it being by this means alone that the operator can 
learn at a glance to what degree the blades have been 
opened or shut, after that portion of the stem which contains 
them has been introduced, to perform its duty within the 
uterine orifice. 
Fig. 2. 
The second figure represents an anterior view of that 
section of the stem which holds the blades, the upper surface 
being removed in order to display the mechanical principles 
upon which they act. The stem, therefore, is seen to be 6 
hollow, and the two blades, lying back to back, are held 
together, and fastened by means of a single pivot to a small 
steel wire, which is made to pass quite through the centre of 
the instrument, from c to 6, fig. 1. When closed the blades, 
of course, overlap each other, to economise space, but obe- 
dient to the screw, (a) they are forced to part, one on each 
side of the stem, in consequence of the steady resistance 
opposed to the inclined plane of their backs, in the shape of 
a wedge. 
The handle is made of some light material; is intentionally 
flattened upon its posterior surface and convex upon its 
anterior. The convexity of the handle corresponds to the 
curvature of the stem, and by referring, therefore, to this 
distinction, the operator is constantly reminded of the direc- 
tion of the point of the instrument, even while hid to the 
handle within the vaginal passage. 
To incise the neck of the womb with this instrument the 
patient is made to lie upon her back, in a convenient position. 
The forefinger of the right hand is inserted into the vagina, 
and its extremity held in contact with the os tineas, to act as 
a guide. The blades being closed, the instrument is next 
held in the left hand, and its point carefully slipped along 
the palmer surface of the finger, until it is finally directed, in 
this manner, through the cavity of the cervix and within 
the os internum. It is then maintained in this position until 
with the right hand, the blades are forced out to the extent 
desired; when, by simply withdrawing the instrument, in 
the same direction as introduced, the operation is fully 
accomplished. To complete the cure, all that remains now 
to be done is to prevent re-union of the cut surfaces, and this 
is effected by means of a sponge tent, or a permanent me- 
tallic bougie, similar to that recommended by Prof. Simpson. 
Whichever is selected should be worn within the parts for 
several days, and only changed as often as cleanliness 
requires. 
My main objects in communicating this paper have been 
not merely to record my approval of Prof. Simpson's mode of 
treating certain cases of dysmenorrhoea by incision, but to 7 
introduce to the profession a new surgical instrument for 
effecting this purpose. I trust that its credit rests not so 
much upon its originality and comparative cheapness as upon 
its especial adaptation to the relief of all classes of strictures 
in which internal cutting would be admissible. 
The instrument in my possession is one which was neatly 
and successfully fabricated at the factory of Mr. George 
Tieman, No. 63 Chatham St., New York. The skill of this 
veteran instrument maker is already too well known to 
need encomium. 
In conclusion, I would simply add that this instrument 
needs but a single application to effect in these cases what 
it requires at leas two or more attempts with any other to 
perform. It offers, consequently, an easier, more expeditious, 
safer, and, upon the whole, less painful mode of operating 
than any other I know of. I therefore recommend its use to 
my professional brethren, hoping that it may be found of as 
much service in their hands as it has so far proved in my own.