THE 
PATHOLOGY AND THERAPEUTICS 
OF 
Uterine Displacements, 
(read in brief before the academy of medicine, n. y.) 
E. P. BANNING, M. D 
Of 96 Tremont Street, Boston 
I BELT EVE it is now generally conceded that the whole domain of medi- 
cine and surgery, unaided by mechanics, must be inadequate to supply 
all the desiderata in uterine obliquities, displacements, and their deriv- 
ative effects, because of their pathology being largely mechanical; and, 
notwithstanding some of the profession have been driven from an exclusive 
medicinal treatment, constitutional and local, to various mechanical devices, 
still, it remains a grave doubt whether, in the aggregate, success has been 
greatly enhanced by them ■ to say the least, all the desiderata have not 
been supplied, and hence I submit a few suggestions touching the reasons 
for this partial success. In attempting this, I shall pretend to no extraordi- 
nary professional intelligence ; and if I should supply the required light, it 
will be due to the purely common-sense view which I take of the obvious 
mechanical forces in the premises, and I shall gladly rest content to leave 
the departments of medicine, surgery and hygiene in far better hands. Pathology of Uterine Displacements. 
Protracted and extended observation has forced me to the conclusion, 
that the prevalent pathology of uterine displacements is more or less defect- 
ive, its ruling idea seeming to be that their physical causes originate within 
and are mainly confined to the intro-pelvic cavity and tissues, where, to me, 
it appears manifest, that the pelvic contents, in the main, are merely the 
objective point, and, that the abnormal pelvic status, both primarily and 
proximately, is caused by a relaxation of the abdominal, dorsal and scapular 
muscles and ligaments, and by a consequent undue gravitation, not only of 
the abdominal contents upon the pelvic organs, but also, of the whole 
trunk, which has lost its centripetal bearings and fallen forward of the 
spinal axis in consequence of a diminished and unbalanced action of its 
muscular braces. 
To illustrate : by a mere glance at Fig. i, we see plainly, that the mathe- 
matical combinations of such a figure, induce first, a centripetal or central- 
ized state of all the trunkal bearings, or, in other words, a balancing of the 
whole superior trunk upo?i and behind the spinal axis, orpoint-d-appui; second, 
a tension of all the abdqminal muscles; a consequent expansion of the 
chest and a protection of the pelvic viscera from abdominal weight by a 
steady and firm compaction upwards of all the viscera. Add to this the 
fact that the medial plane of the pelvis is comparatively vertical, and the 
inferior abdominal cavity (antero-posteriorly) comparatively small. 
By this combination, not only is the descending weight of the whole line 
of viscera materially impeded, but also, the force of visceral gravity is com- 
pelled to fall upon the pubis, and not upon the uterus, rectum and bladder 
in the inferior strait. 
On the other hand, a glance at Fig. 2 shows, almost painfully, that a 
centrifugal state (the very opposite of the former) revels, as it were, through- 
out ; for the spine has retreated behind the proper axis of the body, leaving 
the whole upper trunk to hang forward from the spine, and not to properly 
swing behind or to rest upon it as in Fig. 1. This centrifugal combination 
causes the chest to droop and flatten, the ensiform cartilage to retreat 
towards the spine, the medial plane of the pelvis to become nearly horizon- 
tal like a dish; the distance between the symphysis pubis and the sternum to 
be much diminished and the abdominal muscles to consequently become 
flabby; also, the inferior abdominal cavity is compelled to be enlarged, FIGURE I. 
FIGURE 11. 
Side views of the erect and drooping position, showing the upward and bracing out bearing- of the 
Viscera m Fig. i, and the downward action in Fig. xi. b 4 
antero posteriorly, and the head, shoulders and entire visceral series, made to 
descend, and in consequence, made to press with a corresponding abnormal 
force upon the uterus, bladder and rectum. 
In fact, the contrast between these two figures and their involvements, is 
complete, and whatever inherent causes there may be to produce uterine 
descent, is it not manifest that such a condition of the middle and superior 
trunk as is represented in Fig. 2, must greatly augment and remain at least, 
an obstacle to complete curative action; and, is it not also apparent, that 
this undue pressure must be greatly augmented by the superinduced horizon- 
tality of the pelvis ? 
Therapeutic Indications 
It now being conceded that uterine displacement is wholly caused or 
aggravated by superincumbent weight, light at once breaks as to some of 
the indications of cure. 
First, we should remove the superadded visceral burdens from the uterus 
and its ligaments, by restoring the body to its normal or centripetal bearings 
as seen in Fig. 1, by pushing forward the spinal point'dappui (the dorso- 
lumbar portion of the spine) to an axial line between the ankle and the 
head; thus we restore the normal philosophical bearings of the skeleton 
trunk, (See mathematical diagram, Fig. 1, compared with Fig. 2.) for by 
thrusting this portion of the spine forward into the vertical axis of the erect 
body, the weight of the head and shoulders become oi'evating agents and 
tensors of the abdominal muscles, and also, contractors of the inferior 
abdominal cavity, by being compelled to throw gravity behind the spinal 
fulcrum. 
This has also compelled the upper sacrum to advance and the inferior 
sacrum and the symphysis pubis to dip and to retreat (the sacrum to turn on 
its axis as it were) and thereby to restore the normal pelvic obliquity. The 
obvious result of this, is, to shelter the pelvic organs below and partially 
behind the lumbar spine and the superior sacrum and thus causes the pubis 
and the inferior abdominal muscles to receive the principal abdominal 
weight, (which is supposed to be so burdensome to the uterine ligaments.) 
Thus then, it is conclusive, that this balanced state of the trunk upon its 
own spinal fulcrum and this elevated state of the abdominal viscera once 
established, either by nature or by art, the case is then changed from that of 
a general derangement to a merely local one in the pelvis, and that both in- 
herent and artificial resources are then left to contend only with the merely 
inconsiderable weight of the uterus alone, whereas, before this, they must 
contend both with the weight of the uterus and that of the whole line of 
viscera, together with that of the head and shoulders. 5 
FIGURE 111. 
The Abdominal and Spinal Shoulder-Brace. A, front pad, elevating-the abdominal viscera- 
B B, pads supporting the glutei muscles on either side of the sacrum. 
C C, bows or arches of the main-spring, to which all the other parts are attached, rising above the 
innominatta, and sitting immovably on the body. 
D D, aggressive support to each side of the weak lumbar spine. 
E£, spring support resting on each head of the Humerus. The combined action of all these, is, to 
elevate the viscera, sustain the spine in its proper form, and poise the upper trunk behind the spinal 
axis. BY WHAT MEANS CAN WE RESTORE THE NORMAL RELATIONS OF THE TRUNK 
AND ITS CONTENTS TO THE PELVIC VISCERA? 
Perhaps this question can be best answered, by showing how it cannot be 
accomplished. 
ist. It cannot be done by medicine alone ; for if medicine should remove 
every predisposing cause or constitutional influence, it could not change the 
abnormal mechanical status, the reflex effect of which,* is, to neutralize the 
legitimate action of medicine, at least in confirmed cases. On this point, 
general experience has been so stubbornly unfavorable as to silence all 
opposing reasoning on the subject. 
2d. It cannot be accomplished by any such physical discipline and 
culture as might have prevented the trouble, inasmuch as the laws of preven- 
tion and of removal are not identical, and often bear no analogy to each 
other. 
To illustrate : it is palpable that habitual and energetic muscular effort, 
according to order, tends to generate muscular power; but, when muscles 
have already lost their powers from excessive or too long continued exercise, 
shall we quote the law of labor to the exhausted patient and urge him to 
stimulate his muscles to greater effort? It is also a fact, too, that motion is 
the law of a joint, and that it tends to lubricate the articulating surfaces; 
but, who would think of reducing a dislocation by urging the patient to 
make strong muscular effort ? The truth in the premises is, that the law of 
function and that of casualty are very different. Nevertheless, there are 
those who seeing clearly the necessity of elevating unusual weight from the 
uterus, (when the uterus rests upon the perinaeum, or is even protruding 
through the vulva); place this patient on a system of walking, riding and 
gymnastics, under the idea that the obliquity or gravitation is produced by 
a previous lack of muscular effort, and that the opposite course is the true 
remedy. 
This answers very well for logic, but does not meet the facts ; indeed, I 
have had scores of “ forlorn hopes ” fall into my hands, whom this regimen 
of logic has reduced to the most miserable helplessness, the muscular effort 
having increased the uterine descent, when entered upon after the descent 
had fairly commenced; whereas, in a normal uterine condition such muscu- 
lar effort may tend to preserve that state; the aggregate of muscular action 
being then in the ascendant. With me, such cases of improper effort have 
uniformly borne testimony to an aggravating influence. 
Again, this laxity of the abdominal and dorsal muscles has usually been 
so entirely the result of excessive and protracted effort, that to apply the 
law of labor to them, as an excitant, is simply absurd ; as much so, as to 7 
shout to an exhausted man grasping a rope over a precipice, and unable to 
turn above the rope :—“ Keep on exerting your muscles till they acquire 
strength thereby to raise you up onto the rope,” whereas, the only trouble 
is, that his weight by previous effort and stress, have already reduced him to 
helplessness; such, indeed and in truth, has been my observation on this 
point, that to confine such patients to constitutional remedies and to urge 
muscular effort is but to actually insult the patient. Thus then, it is evident 
that in confirmed cases, a correction of the trunkal bearings and the eleva- 
tion of visceral weight from the uterus will not be effected by muscular 
effort or medicine, either used separately or in conjunction. 
We see then, that our main hope lies in the application of such mechani- 
cal force at the shoulders, dorso-lumbar spine and inferior abdomen as shall 
concordantly and at once, push forward the dorso-lumbar curve of the spine ; 
draw backward the shoulders behind the spinal axis, and elevate the whole 
line of trunkal viscera. This, should be done, partly by some force at the 
first, and lastly, by a sort of provocative action, which, under a proper regi- 
men, will gradually educe the inhering muscular resources. Accordingly, I 
have for the last forty years made it the study and labor of my life to devise 
such a combination of mechanism as shall supply the above desiderata, 
and yet act in accord with the physiological law of muscular education. 
See Fig. 3. It represents the combined abdominal, spinal and scapular 
muscles, or forces of the trunk, in the simultaneous or separate exercise of 
power, and consists of the following three points, namely : First, an abdomi- 
nal pad looking and acting upward. Second, a steel spring or spine with a 
supporting saddle or spinal fulcrum pushing the dorso-lumbar spine forward. 
Third, a shoulder-bow (or steel scapular muscles) looking and drawing 
backward. 
When this combination (which I denominate an abdominal and spinal 
shoulder-brace) is applied to the subject with settled viscera, a retreating 
lumbar spine and advanced shoulders, an immediate and general change in 
the external appearance and internal condition is palpably accomplished, 
i. e., the spinal, abdominal and shoulder parts force the viscera upward, the 
dorso-lumbar spine forward, and the chest and shoulders backward, thereby 
effectively giving relief to the pelvic organs from superincumbent visceral 
pressure by visceral elevation, waist and chest expansion and the poising 
of the superior trunk behind the spinal axis. Meantime, it is particularly 
worthy of remark; that all these changes are effected almost in a natural 
way, without restraining the free action of a single muscle, the compression 
of a single nerve, blood vessel or cartilage, or the constraint of a single 
motion; but, on the contrary, so concordant, yielding and provocative is the 
action as to excite the dormant resources to an increased effort. 8 
FIGURE IV. 
A A, curved shaft to be attached to front bar of the brace, adjustably, and to support the small ring. 
3, small rubber or celluloid ring, which fits loosely around the cervix, and by means of a golden 
spiral wire, gives an undulating action under the jolts of the body. 
C, A pinch-screw, by which the ring may be elevated or depressed at pleasure. 
D, A hinge, by which the ring may be turned on its edge for easy introduction. 
E E, steel slotted pendant, for supporting shaft and ring 3, when in situ on the body. 
E, Thumb-screw for adjusting and fastening the ring at any desired position in the body. 9 
OF SIMPLE UTERINE PROLAPSUS AND PROCIDENTIA. 
This simplest and least painful variety of uterine displacements is the 
most easily met. It consists in a direct descent from the superior to the 
inferior strait of the pelvis, without either lateral, backward or forward ob- 
liquity. Its low altitude in the cavity is the only troublesome fact, and the 
examining finger shows the descent to have inverted, shortened and expand- 
ed the vagina, whereas its most contracted diameter and extended length is 
requisite. In this low state, the uterine ligaments and their attendant 
nerves are most tensed, and their insertions tracted. Thus we have a ra- 
tional explanation of the “dragging,” “wrangling,” “boring,” and “tooth- 
ache feelings in the back and groins,” and the feelings of “ openness,” 
“turning inside out,” or “feeling as if something wanted to be born at the 
vulva.” 
Again, this state does not always stop even here, but superincumbent 
pressure and constant stress upon the vulva, ultimately so overcome the 
tissues that the uterus protrudes through and is carried between the thighs 
through the day like an oblong ball. 
CURATIVE INDICATIONS. 
Quite commonly, even at this late day, men of renown and gray hairs 
attack such cases with tonics, order the recumbent posture and apply a 
pessary. 
But the tonics can only give some general strength, whilst recumbency in 
giving respite from suffering, tends rather to diminish than to increase mus- 
cular tone; and I blush to say that many venerable men carrying out this 
plan, will spend months and years in calling once or twice a week, and with 
great solemnity and gravity replace the uterus, and gain a reputation for 
“great faithfulness ” in the case; whereas, it would be as reasonable to 
place an egg on end on a table so often, in the hope that by and by it will 
stand. 
OF PESSARIES. 
Others, a little more sensible, (and but a little) resort to pessaries. Of the 
varieties of these, there is a legion. But no matter what their shape, if they 
give any support, they must do so by resting for a point of support upon the 
vagina and perinaeum, whilst they need supporting themselves. In doing this, 
they necessarily distend the already relaxed and distended vagina and peri- 
naeum, which will gradually recede under their burden, and require a larger 
and still larger pessary, and thereby, whilst giving some relief from the effects 
of uterine gravitation, they steadily exhaust all the remaining contractibility 10 
in those tissues and thus wear out all hope of their again playing their part 
in sustaining the uterus in situ. 
But not only this ; they often work immense mischief by inducing ulcera- 
tion and inflammation of the vagina and uterus, and have at times actually 
ulcerated through the bladder and rectum. I have often traced with my 
finger, a horizontal gutter around the vagina and also the uterus, especially 
under the action of the cup pessary with an external base, caused by 
their continued pressure; in many instances, they become imbedded in the 
tissues so as to make it both painful, difficult, and in some cases, dangerous 
to remove them. I have been young, and now am old, and I can testify, 
that pessaries have played a terrible part in producing the most obstinate 
forms of intro-pelvic irritation and inflammation. Indeed, a man desirous 
to treat such conditions, has only to seek a region where the physicians 
make a free use of pessaries. 
The modus operandi of these effects is simply this: In proportion as the 
pessary really does support the uterus is something as the sweep supports 
himself, by pressing back, knees and elbows against the chimney—not only 
it has to support that organ, but has to compel the uterus to support the 
abdominal viscera (and the whole upper trunk in a measure). Thus, be- 
tween the action of the fixed and upward pressure of the pessary on the one 
hand, and the pressure by the superincumbent parts above and downward, 
ulcerative action is almost necessarily induced ; and not only so, but by 
holding the uterus up under such a down pressure, ante and retroflexions are 
established. 
Again, and lastly, the very best pessary can only act by catching and hold- 
ing a sinking body, and do nothing towards removing the producing cause? 
viz : the effect of superincumbent weight. Were they harmless, they oper- 
ate only on the ultimate or effect, and never on the cause, and consequently 
without prospective success. 
Another class of men, seeing the distending and weakening effect of pes- 
saries on the vagina and perinaeum, attempt to remedy this by using smaller 
pessaries with an external base, obtaining a fixed point by belts and straps 
around the pelvis ; but, whilst they do obviate the distending and weakening 
effect on the vagina and perinseum, they produce far more cutting and ulcer- 
ative effects upon the uterus by forcing that organ against superincumbent 
weight, for they exert no rebalancing of the body, and no elevation of the 
upper trunk from the uterus. This last class (the cup pessary) has earned a 
very bad eminence for inducing uterine versions, flexions, also gutters in the 
uterus. 
But, when we turn to the true idea, muscular laxity and a consequent 
false trunkal bearing and settled condition of the abdominal organs which 
act in the axis of the inferior in lieu of the superior strait of the pelvis, the 11 
rational mind sees at once that the first, foremost and paramount indication, 
is, to remove all the abnormal superior weight from the uterus, by pushing 
forward the dorso-lumbar curve, drawing back the chest, and thereby caus- 
ing the pubis to dip and retreat, so as to not only lift weight from the uterus, 
but also to shelter it from weight by the compound mechanical combinations 
of the body, as in Fig. i. This done effectively, uterine ligaments, vagina 
and perinaeum are left to contend only with the two ounces of weight in the 
uterus. This is pleasurably accomplished by the abdominal and spinal 
shoulder-brace. See' Fig. 3 and its previous description. 
RESULT. 
I have now been engaged many years in the constant application of 
this instrument, (in many thousands of cases) of simple prolapsus, and find 
that in nearly all the cases where the uterus is not very low upon the peri- 
naeum, (consequently below the benefiting action)-the results have not only 
been immediate comfort, but steadily improving strength and spirits, and an 
ultimate recovery; and why ? Simply because the normal trunkal bearings 
were restored, superincumbent weight removed from all the intro-pelvic tis- 
sues, and the perinaeum, vagina, vulva and uterine appendages were rested 
and enabled by their returning contractibility of texture to triumphantly 
buoy up the simple two ounces of uterus in situ. 
After this, if the constitutional condition requires constitutional remedies, 
give them; but in no case waste any time in that way until you have thus 
attended to the upward compaction of the settling organs and upper trunk. 
But, in very great depression of the uterus within the pelvis and espec- 
ially in cases where the uterus extrudes, then the above instrument about 
invariably aggravates the effects of the prolapsus, by crowding and holding it 
still lower; or, to say the least, it can merely give great rest to the spine 
and lower abdomen without specially improving the uterine condition. 
THE UTERINE ELEVATOR. 
But, in all such cases, aggravated ever so much by the Brace, the instant 
we give the slightest vertical support with the hand, the sense of support is 
complete; for only a slight elevation of the uterus raises it within the up- 
ward action of the brace, and every tissue finds rest, and commences to ex- 
pend its remaining resources in returning to their normal state of tonic 
contraction and not in exhausting and hopeless efforts to resist their merci- 
less burdens. 
To meet this indication, I have constructed the uterine elevator. See 
Fig. 4. 
This instrument consists, first, in a small, celluloid or rubber ring, (only 12 
Retroversion Balance.—A A, curved shaft occupying the vagina vertically, and curved so as to 
correspond to both the inferior and superior pelvic straits, and not to infringe upon the uterus or 
FIGURE V. 
rectum. 
E, thumb-screw for fastening the outer shaft at any desirable point on the steel pendant supporting 
the shaft. 
G, celluloid or rubber ring, mounted on a gold spiral wire in the shaft, for giving an undulating 
motion to the ring, under jolting motions of the body. 
B, heel of ring extending high behind, supporting the posterior cul-de-sac thereby drawing back the 
os and pushing forward the fundus. 
C, Set screw for regulating the height of the ring or balance, and for turning the balance to meet 
any degree of lateral mal-position. 
E E, the slotted pendant attached to the front part of the brace, and supporting the balance. 13 
large enough to loosely receive the uterine cervix) which, by means of a 
hinge, is mounted on a shaft containing a gold spiral coil, which gives a 
yielding undulation to the ring, under all the movements of the body, such 
as walking, coughing, sneezing, etc. This is also mounted on a shaft, so 
curved as to fit the vaginal curve, around the symphysis pubis externally, and 
ascend towards the front bar of the brace, to which it is attached by the 
medium of a slotted steel pendant, and its position fixed by a thumb-screw. 
When introduced and attached to the brace, the brace having lifted nearly 
all weight from the uterus, the elevator has to exert but about two ounces of 
yielding support to the uterus, which meets now with no opposing visceral 
obstruction to its easy elevation. 
Thus we see, that by this gentle and unirritating means, the vagina is 
elongated and diametrically contracted, and the perinaeum and vulva are at 
rest from their exhausting burdens ; and all this without one contraband 
action against physiological law. 
CONTRA-DISTINGUISHING FEATURES OF THE ELEVATOR AND PESSARIES, 
They are many and clearly defined 
ist. Pessaries have to be large enough to hold themselves in position 
under weight; but the elevator is too small to support its own weight, or 
even to remain in the body. 
2d. Pessaries have no external base, and rest on other weak parts for a 
point; whilst the elevator and all my other intro-pelvic supports, have an ex- 
ternal brace and place no stress on any tissue, but rather rest them. 
Pessaries can do nothing but support; but these intro-pelvics have but 
two ounces to support, all other superincumbent weight having been removed 
by the elevating and uprising action of the external brace. 
Owing to the great sameness of the many hundreds of cases, illustrating 
the working of the brace and elevator, I omit the citation of any. 
OF RETROVERSION. 
The physical facts are simply these : our examination usually shows the 
uterus not only to have subsided, often to the perinaeum, but also to be 
occupying a horizontal position with the fundus resting with more or less 
force upon the rectum and hemorrhoidal veins, the os looking correspond- 
ingly forward and upward, behind the pubis. In this case, very commonly 
the fundus will be found so enlarged from venous congestion, as to lead 
the practitioner to diagnose an induration, and often a fibroid tumor; and 
I am sorry to know of several experts who have committed this blunder, 
and have governed their course accordingly for years, of course with no 
good result. In this case, such a misdiagnosis is fatal to both the patient’s 14 
hopes and pocket. As to the position of the organ, perhaps a bell-pear 
lying in a basin of water will about accurately describe the uterine situation 
in retroversion. 
In this condition, obviously, both the round and broad ligaments must be 
elongated and tensed, comparatively, and their points of insertion subjected 
to a more or less dragging or trading force, and the bladder must also be 
more or less dragged downward and backward, and sometimes so much so 
as to cause difficult urination from the flexion thereby caused in the urethra. 
All these things, taken together, furnish the clearest explanation of the fre- 
quent sense of tormina and pressure in the sacrum ; the desire to evacuate 
the bowels, and the sense of physical obstruction in attempting to do so; 
also, the annoying, dragging sensations at the insertion points of the round 
and broad ligaments, and the more or less perpetual desire to urinate, with 
an unsatisfied feeling on making the attempt. 
INDICATIONS, 
Of course, two things are indicated, namely : ist, to restore the proper 
axis or vertical position to the uterus ; and next, to elevate it to the superior 
strait of the pelvis But, the accomplishment of these indications with any 
considerable facility to any comfortable degree, has, so far as I can learn, 
signally fallen short of the object, so little benefit having been derived from 
the means used, as often to leave physician and patient in grave doubt as to 
whether the end gained has justified the means. To restore the uterus to 
situ in the recumbent position is usually an easy thing, but, to retain it 
there in the vertical position is quite a different thing. 
The exigencies of the case have compelled the use of a variety of means 
with nearly an identical result. The globe pessary has elevated the organ 
some, but done nothing towards restoring its normal axis, (the most impor- 
tant thing) and, in the meantime, it has done much towards instituting 
uterine flexion by its pressure on the os, whilst superior weight was resting 
on the fundus. Indeed, the end is always worse than the beginning. 
Next, the elastic rubber ring has been used ; but in order to prevent its 
tilting on its axis, under weight of the viscera and uterus, particularly in 
defecation, it has to be so large as to distend the vagina inordinately, and 
often, to injuriously infringe on the bladder and rectum and to work very 
serious mischief, by irritation, ulceration, absorption and inflammation. 
But the more frequent and very serious evil is, that it slips under the uterine 
weight so as to hit the fundus behind it, and thus cause the ring to rest on 
the uterus midway between the os and the fundus and thereby to produce 
flexion by the uterus breaking its back over it, also causing sickening pains 
in the organ, together with congestion of the fundus by an obstruction of 
the visceral circulation by the same pressure. 15 
But, perhaps the horse-shoe pessary, of Dr. Hodge, curved so as to pass 
up behind the uterus, has, in skilful hands, been the most useful; but it, too, 
has weakened the vagina by reason of the extent of its circumference, irri- 
tated the rectum by pressure upon it, and usually failed to be reliable, 
because of its liability to turn under visceral and uterine weight, unless 
it was so large as to produce exciting and ulcerative pressure on the vagina 
and rectum. Often have I found these results, on their removal. Indeed, 
such must be the action of all pessaries which have only an internal base, 
for they must ever lack a fulcrum or fixed point. 
Appreciating this dilemma, the distinguished Dr. Simpson of Edinburgh, 
introduced the stem pessary. This instrument, by occupying the uterine 
cavity and using the cirvex as a fulcrum, compelled the uterus to take its 
position; but, as might be expected, from so unnatural a process, (with few 
exceptions,) most undesirable and, sometimes, unmanageable results have 
attended, such as uterine irritation, inflammation, flooding and too frequent 
menstruation. Besides all this, it never could become reasonably self-man- 
ageable by the patient herself ; consequently, in America, this nearest ap- 
proach to the desideratum has passed almost into disuse. In this forlorn 
state of things, physicians gloomily compare notes, and then, with a shrug 
stare each other in the face. 
Having myself, for many years, been compelled to succumb to the general 
professional incompetence in the premises, and goaded on by a humane 
humiliation under the great necessity in the case, I have, after inexpressible 
trouble and discouragements, succeeded in perfecting a device which I de- 
nominate the 
UTERINE RETROVERSION BALANCE, 
which, attached to the abdominal and spinal shoulder-brace for an external 
base has, thus far, perfectly met the requisitions in all cases. 
What is particularly to be noticed, is, the trifling degree of support or up- 
ward force to be used upon the cul-de sac in consequence of the centripetal 
working of the abdominal and spinal brace, by which the balance has to 
contend only with about two ounces of floating uterus, whereas, but for 
this, the balance must contend with an indefinite amount of opposing 
weight from above, and from the weight of female apparel, which must be 
correspondingly enhanced by the liability to ulcerative pressure upon the 
susceptible intro-pelvic tissues. 
Another important feature is, that contact with a congested or ulcerated 
uterus or vagina which may be undergoing local treatment, is completely 
obviated. 
In all the hundreds of cases in which I have applied this arrangement, 
(all things equal) the most bedridden patient has immediately commenced 16 
FIGURE VI. 
Antkversion Balance.—A A, Shaft curved so as to just fit the vagina, and the arch of the pubis 
when it leaves the vagina and passes up in front, to be attached to the brace. 
H, hollow, jumping or undulating cylinder, to which a free and yielding undulation is given by 
means of a golden spiral coil within it. 
I, curved shank or goose-neck entering the cylinder B by a screw shaft, which allows of any desired 
elevation or depression. 
C, set-screw fixing the goose-neck at any degree of circular position in the vagina. 
B, oblong ring mounted on the goose-neck and curved to be attached to front bar of the brace. 
E E, vertical slotted pendant receiving the shaft A, at one end so as to carry the vagina high up 
between the bladder and uterus. 
F, thumb-screw to hold balance to pendant. 17 
exercises and enjoyments, and all the varied sympathetic concomitants have 
begun to subside. 
Another important desideratum is supplied by this balance, viz ; it will be 
noticed that the ring can be turned in a circle to the right or left, so as to 
meet any degree or variety of obliquity or laterality, by simply turning its 
goose-neck in the shaft where it enters it and is fastened by a set screw. 
This meets a crying want which has caused much trouble and yet has 
never been fully, met. 
CURATIVE ACTION OF THE BALANCE IN UTERINE CONGESTION AND 
ULCERATION, 
And here I must not omit to notice a most important and overriding fact 
in the repositing of the uterus by this combination; one indeed, which bids 
fair to mark an era in the management of uterine congestion and ulceration, 
namely: I have found invariably, that when congestion and ulceration 
are complicated with prolapsus or versions, when the latter are fully and 
quietly removed by the above plan, the former have ever very soon com- 
menced to improve, and, as a rule, to ultimately disappear. This fact, at 
first took me by surprise, but the frequency of its occurrence soon led me to 
see that it was in accord with our fundamental proposition, that, “ the vis- 
cera are as much under the law of an ordained primary position and bear- 
ing as the bones, and that derangements requiring mechanical aid will follow 
any change, in this respect as well as in the other.” In this case, the mal- 
position has disturbed the vital status, and acted as an excitant or an irri- 
tant, which no medicine or local treatment can ever fully meet, until the 
primary law of position and bearing is restored to rule. 
So it is in luxations,—swelling, inflammation, pain, fever, tetanus, etc., 
ensue, threatening life, but all these instantly subside on reducing the 
luxations; and just so is it with uterine displacements, and now after many 
years of extensive experience I have not felt called upon to treat locally 
one tythe of the cases I formerly did; and what makes this idea very sig- 
nificant is this fact, that in several severe and protracted cases where the 
most eminent men had spent years (at intervals) in treating, by various sub- 
stances, to get the uterus in a fit condition for reposition, I have induced a 
rapid cure by at once repositing, irrespective of soreness or ulceration. I 
here add my solemn protest and charge against wasting the time, strength 
and money of the patient by treating persistently the mere ultimates of the 
malady, and leaving the mal-position (the real provocative) unattended to. 
As to cases, out of great heaps of them I select but two or three as rep- 
resentatives, and refer to my “ Pathology and Therapeutics ” for reports of 
others, from prominent practitioners. 18 
Case i.—Mrs. McK., age, 32 ; no children; was the subject of complete 
and inveterate retroversion, for many years, accompanied by a remarkably 
atonic condition of the vulva and vagina, there seeming to be no remains of 
contractility in them. The bladder was so drawn backward and down as to 
cause a constant propension to urinate, and the rectum was so compressed 
as to impede defecation and induce a constant sensation in the sacrum, of 
“boring,” “aching,” “weight, and the feeling of a flatiron resting in the 
hips,” which was aggravated on standing and walking. All these were at- 
tended with that mental depression, pain and sense of weight and pressure 
in the top of the head, which are so usual in such cases. 
To reposit the uterus, or to attempt retaining if by any of the various 
pessaries, was of no use, except when the instrument was so large as to 
strangulate the intro-pelvic, sanguinous and foecal circulations. In this 
state, she was sent to the care of the most distinguished uterine manip- 
ulator of this country, Dr, Hodge of Philadelphia, where she enjoyed 
for months the assiduous care of that gentleman, several times a day, but 
gained nothing but the benefits of rest and sympathy. In this case, the 
horse-shoe and double lever pessary of Dr, Hodge had the fairest chance 
in the Doctor’s own fingers, for months, and failed; the inconveniences of 
its use proving to be paramount to its advantages. When not so large as to 
strangulate, it would invariably tilt back under uterine and abdominal weight. 
At this forlorn stage of the case I was placed in charge, with orders 
“ never to give up.” The abdominal and spinal brace gave much comfort 
by supporting the spine and abdomen, but rather aggravated the retroversion, 
the abdominal support acting so much above the retroverted uterus; nor 
could I possibly make any of the various pessaries comfortably retain the 
uterus in axio. In a fit of vexation at the idea that the combined profes- 
sional ability of the old and new world could not balance two ounces of 
uterus, I examined the lady in a vertical position to see what could be the 
matter. In doing this I was surprised to notice that such was the expan- 
sion of the flabby vagina as to allow my two forefingers to pass between 
the uterus and rectum, entirely above the uterine fundus, so much so, as to 
draw the os against my finger at its junction with my palm. I also noticed 
that as the finger carried up the posterior cul-de-sac; the superior vagina was 
thereby so tensed as to forcibly pull back the os and consequently to poise 
the fundus over it. With the external brace on, this required no force, 
causing the woman to rise on her toes and fall heavily on her heels with a 
“chug” whilst my fingers supported the posterior cul-de-sac. I noticed no 
disposition of the uterus to settle or retrovert; I also noticed that whilst 
doing this, the shortened and expanded vagina became materially elongated 
and correspondingly contracted diametrically, (two cardinal requisites, of 
which every pessary must be contraband.) 19 
“ There,” exclaimed the lady, “ hold me so all the while and I’ll be in 
heaven.” 
This irradiated the darkness, and showed that after having first corrected 
the trunkal bearings, we were left to contend only with the weight of the 
uterus, and should never make the uterus a point, but merely support and 
carry up the cul-de-sac, and the work is done; for this drags back the os, and 
that compels the fundus to advance and be poised over the os. Thus then, this 
long, rough and tortuous road was smoothed, shortened and made easy; and 
furthermore, I learned that had Dr. Hodge effectively corrected the trunkal 
bearings, and then have reduced his large pessary to one-third its usual size, 
and supported it by an external base, he would long ago have seen the 
travail of his benevolent soul, and thus by his genius and the prestige of his 
great name, had this fight with uterine retroversion brought to an end. 
For this lady, I at length developed the Retroversion Balance, and com- 
pletely met the case; and I must add, that my efforts in this case, one of so 
many distinguished failures, proved to be the fulcrum of the great desidera- 
tum in uterine obliquities. 
Case 2.—Mrs, , a young married lady in good general health, was 
the subject of severe retroversion. Prof. Stephen R. Smith of Bellevue 
Hospital College, describes it to me thus. He says :—“ Uterus greatly 
elongated and enlarged and so tender as not to admit of being touched ; 
the tenderness extends throughout the vagina and vulva ; so much so, that 
to introduce the finger gives the most unbearable pain. The os is high up 
and behind the pubis, and the fundus presses so violently upon the rectum 
as to cause the merest fluid dejections to give excruciating suffering. The 
uterus is also fixated immovably; scarifications, leeches and other means 
have failed to ameliorate, and with the constant use of heavy doses of 
morphine, the patient’s moans disturb the boarders throughout a four story 
house; in this dilemma, I consulted Dr, , (the most distinguished 
member of the faculty of Bellevue College) who, in a careful examination, 
advised recumbency, together with leeches, scarifications, glycerine and 
other depletants, for about six months ; ‘ after which, you will,’ said he, 
‘be able to reposit the organ.’ Thinking this to be cold comfort, I took 
your article on Uterine Displacements, (which from the first had impressed 
me very much), and immediately determined to give you the case, if you 
would take it.” 
Next day, we jointly visited the woman, and a more pitiably distressed 
object I never met. I placed her in the knee and face position and directed 
Dr. S. to powerfully draw the abdominal organs upward, whilst with my 
thumb in the rectum I got under and behind the uterine fundus, and by 
violent pushing, dislodged the uterus from its bed and restored it to situ. I 20 
then applied the Abdominal and Spinal Shoulder-brace and introduced the 
Balance which, without force, held the organ in situ. In an hour, the 
woman said she was “in heaven.” In a week, she returned well to Boston, 
and has so remained, now ten years since. This case will be found, as 
reported by Prof. Smith in the “Philadelphia Medical and Surgical Re- 
porter ; ” also in my “ Mechanical Pathology and Therapeutics.” 
Case 3.—Mrs. Judge B. of Patterson, N. J., age 35 ; general health and 
physique good; was very desirous for offspring and had for one or two 
years been steadily under local treatment for enlargement, congestion and 
ulceration of the os. She stated that cauterizations effected temporary im- 
provements, which were always followed by relapses. Digital examination 
showed decided retroversion, with enlargement of the whole organ. The os 
was swollen and tumid, and of a purplish or livid color, and covered with a 
tenacious layer of mucous. I corrected the trunkal bearings by the external 
brace, and reposited the uterus with the Retroversion Balance, and declined 
to treat the diseased condition of the uterus, predicting that the latter 
would subside in due time just as swelling and pain subside when a luxation 
has been reduced. 
On the fourth day, the uterus was found perfectly in situ, its size greatly 
reduced, and the swollen and purple appearance of the os was displaced by 
a nearly natural size and a natural pinkish color, with no mucous coating 
over it. On asking the judge to look through the speculum, (for he was 
familiar with its use), he remarked:—“ Well done, Doctor, that shows the 
difference between fine and coarse practice. Any one can persevere in 
burning a uterus for months, but it takes you to cure one without.” 
In two weeks she became enciente, and she has (now some several years 
since,) been a healthy and happy-woman. How long would it have taken to 
establish this result by a simple system of cauterizations ? 
Thus we see the curative effect of simply reducing the uterine luxation. 
OF ANTEVERSION OF THE UTERUS. 
Of this uterine displacement, so near akin to retroversion, there is a 
numerous class, than which, uterine retroversion has ever proved more in- 
tractable. A digito-vaginal examination usually shows the following con- 
ditions, viz ;—The vulva is found full and flabby; the labia disposed to be 
separated, and there frequently will be felt a small tumor pressing with more 
or less force in front, crowding upon and pushing the urethra before it. 
Quite frequently, this tumor is completely extruded, or rests in the meatus ; 
but, on assuming the recumbent positions it pretty uniformly recedes. On 
carrying the finger back, the os is found quite posterior to its normal central 21 
FIGURE VII. 
The Abdominal, and Spinal Shoulder-Brace and the Retroversion Balance Combined 
for both Version and Flexion.—Simultaneously poising the superior trunk behind the dorso- 
lumbar spine; expanding the chest; bracing the weak spine; restoring the normal obliquity of the 
pelvis and elevating all the abdominal viscera from the bladder, rectum and uterus. (See Explanation 
of Fig. 3.) 
Also, the balance attached to the brace, just curved to the vagina, its apex ascending high behind the 
uterus and supporting the posterior cul-de-sac, and its free end loosening the uterine cirvex, thereby sim- 
ultaneously drawing back and down the os, and crowding up and forward the fundus to axio, without 
making the uterus a point, or infringing upon any diseased point, or interfering with the progress of 
any local treatment, when in position, the ring or balance also turning on its axis so as to meet any 
degree of laterality in the mal-position. 
The Balance, in nearly all respects, differs from a pessary. 22 
position in the pelvis and the fundus either resting upon the bladder or 
fallen against it, and by the weight of the abdominal viscera, is crowding the 
bladder before it. 
This protrusion of the bladder and urethra has given rise to the idea that 
this condition is a “ hernia of the bladder,” (and, indeed, sometimes may be 
such,) but, inasmuch as I have usually found these states accompanied by 
an anteverted condition of the womb, I can see no reason for so naming it; 
for, evidently, the settled abdominal viscera and the uterus, are the power 
and not the consequence. Anteversion of the uterus then, it appears to 
me, is the usual proper name, and this, more especially, as I find that a 
proper correction of the anteversion, invariably relieves the whole train of 
symptoms. With this, the description of the patient corresponds, to wit:— 
“Constant desire to make water,” “heat and irritation about the parts,” 
“a feeling of openness, as though something wanted to be born,” “drag- 
ging feelings in the groins and a bearing down in front, with misery in the 
back.” 
INDICATIONS. 
Obviously, these are :—ist, to correct the trunkal bearings by elevating 
the viscera, pushing forward the dorso-lumbar curve of the spine, and poising 
the upper trunk over or behind it. This removes aggressive weight away 
from the uterus and bladder. 2d, to reposit the uterus in axio by carrying the 
anterior cul-de-sac so high up between the uterus and bladder, as to compel 
the superior vagina to drag forward the retracted as, and of consequence, to 
throw the uterine fundus back to situ. 
But, this cannot be done by the Retroversion Balance, which acts so 
happily in retroversion, for in retroversion the os had to be dragged down- 
ward and backward, and the fundus pushed upward and forward; whereas, 
in anteversion the os has to be drawn forward, and the fundus elevated and 
thrown backwards; in other words, whilst the same principal is to be em- 
ployed in anteversion and retroversion, the application has to be exactly re- 
versed, just as the cases are reversed. To meet this indication, I simply 
shorten the vaginal end of the shaft (because the anterior vagina is shorter 
than the posterior) and turn the supporting heel of the ring from backward 
to forward, so that it elevates between the bladder and uterus in lieu of 
between rectum and uterus. See Fig. vi. 
By the retro and anteversion balance, the oblong ring performs two offices 
besides the simple elevating one, viz:—The higher it is carried up in the 
vagina the more it compels the os to be dragged backward or forward, (as 
the indication may be), and thus forces the fundus correspondingly forward 
or backward, without making the uterus a point; thus the uterus turns upon its 
axis, and it is balanced without the possibility of ulcerative pressure; this 23 
latter immunity being the result of the yielding action of the spiral coil in 
the cylinder on the one hand, and the full removal of superincumbent pres- 
sure on the uterus. 
I have for many years been applying these principles in hundreds of 
cases of retroversion, anteversion, and lateral obliquities, with almost uni- 
versal success, after all other methods have failed. 
Case i.—Mrs. , been married two years; had been confined to bed 
about same period with attack of syncope on every attempt at rising; com- 
plained of terrible sense of faintness, or “goneness” at the stomach; feet 
constantly cold, and nearly useless. There was a constant biting and 
imperious desire to urinate, and complained that, when she did, she “couldn’t 
make out anything.” Her very able physicians after trying every cob- 
bling arrangement by pessaries, had given up in despair. 
When I saw her, the anteversion was complete, and the uterine fundus 
had settled down behind the bladder so as to press and to retrovert it par- 
tially and destroy its retaining capacity. In this most forlorn hope, I ap- 
plied the Abdominal and Spinal Shoulder Brace, and then the Anteversion 
Balance, which acted instantly to a charm in repositing the uterus, both as 
to its axis and its height. Her physician examined the case and was wild 
with delight at finding it just as it should be, and especially, to see the os 
dragged well forward, as well as the fundus thrown back. Patient spoke 
particularly of a feeling of calm and quiet coming over her, with greater 
freedom of breathing. v 
This lady I immediately raised to a sitting posture on the edge of the bed, 
notwithstanding she protested it would kill her; after rubbing her limbs 
awhije, with arm around her waist I raised her to her feet, and after a short 
time, walked with her around the room—with none of the old syncope or 
unbearable uterine or urinary sufferings. On the next day she rode seven 
miles into town to be under my care ; and within four weeks she returned to 
her home to take personal charge of her domestic affairs. In truth, so 
wonderful was this change, as to be the excitement for a radius of many 
miles. In meantime, nothing else whatever was done. 
The lesson we learn in this and other cases, is, that not only will this 
combination meet all the requisitions in anteversions, but, that a vast number 
of serious and frightfully nervous and sympathetic concomitants immediately 
commence to find their quietus. 
Case 2.—Mrs. H. Cleveland, age 35, says;—“At the age of 11, I fell 
on my sitting place, and felt something give way, and from that hour to this, 
I have not known one hours’ rest from a biting desire to urinate.” 
An examination showed a positive anteversion, with the uterus pressing so 24 
against the bladder as to diminish its size, and also to frict upon it in all her 
movements. 
To this extreme case I of course applied the abdominal spinal shoulder- 
brace and the anteversion balance combined. In a little time she remarked : 
“Doctor, this is the first half hour I’ve spent free from severe distress, for 
twenty-five years.” Owing to the great irritability of this case, it’ required 
«=ome days to overcome all the uneasiness connected with the presence of 
ne Balance near such very sore parts; but soon it adjusted itself, and she 
has ever since, (four years) been a comfortable woman ; and I now feel 
called upon to say to the profession, that the desideratum is now supplied 
for those forlorn cases in which, heretofore, we have not enhanced our pro- 
fessional prestige, and certainly have not met the crying demands of a very 
numerous class of sufferers. 
And now, in taking leave of this subject, I beg to remind the profession 
again, that not only will the foregoing principles, well applied, fill the 
requisitions, but remove or ameliorate concomitant indurations, conges- 
tions and ulcerations on the simple principle of having placed a quietus on 
their provocatives; and also, to urge the early reposition of the organ, irre- 
spective of any diseased condition of the tissues, for I have found, that in 
many cases, the very tenderness which seems to forbid the presence of the 
Balance, will soon commence to subside under its presence; nor need this 
seem strange, since the pain, swelling, fever and delirium subside on reduc- 
ing the luxation, and since other diseased conditions improve on being 
placed in a state of passivity. 
N. B.—This pamphlet is presented by the Banning Celluloid Sup- 
porter Co,, of 96 Tremont Street, Boston, Mass,, who, under Dr. 
Banning’s personal supervision, manufacture all of his various appliances. 
Dr. Banning will be happy to see any member of the Profession, or corres- 
pond relative to cases. 
Entered according to Act of Congress, in the year 1879, by The Baitoikg Celmtloid Sutpobteb 
Co., in the Office of the Librarian of Congress, at Washington.