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OF
IMALES AND THEIR DISEASES,"

V-'
*
WITH
AN ESSAY
DISPLACEMENTS OF THE UTERUS.
BY JOHN W. HOOD, M D.
" Anatomy should be the basis of all medical reasoning."
     PHILADELPHIA :

PUBLISHED BY GRIGG & ELLIOTT.

        1848. 
 
        A REVIEW


"FEMALES AND THEIR DISEASES,"
              WITH

          AN ESSAY
               ON
 DISPLACEMENTS OF THE UTERUS.

      BY JOHN W. HOOD, M. D.


  " Anatomy should be the basis of all medical reasoning."
     PHILADELPHIA:
PUBLISHED BY GRIGG & ELLIOTT.
         1848. 
 
PREFACE.
  In presenting to the medical  profession  the
various  instruments I  have contrived and tested
in my  practice,  it was  my intention to have
placed them  in their  hands, with the assurance
that  important  service could be  obtained from
their use; but, while planning the course to be
pursued, and, while framing the  instructions to
my agent, a singular  book, under the  title of
" Females and Their Diseases," made its appear-
ance, and obliged me to change my course for the
purpose of noticing its absurdities.  In it, how-
ever, besides  an egotistical display of words—an
uncourteous and unkind  allusion to the  gentle-
men of his cloth, and many blunders that will
readily present themselves to the practical anato-
mist, I  found my  supporter, in connection with
others,  ridiculed  and  condemned.  But,  as  the 
IV
arguments are without the authority of reason,
and  only sustained  upon  the veracity of the
author, it is presumed that its progress as a re-
medial agent will not be checked.—The fact that
some of his patients are wearing  it,  and recom-
mending it to others, leaves the impression that
the book has been written for other purposes than
the cure of the diseases of females.  The declara-
tion " that  one fifteenth of the human family is
asserted to labor under hernia,"—that " the belly,"
which he says is a vacuum plenum, " is too small
for its contents"—that " the thanks to Heaven,"
that the  name of his friend is not found  in the
newspapers—with "the  ignorance of authors,"
and " the dullness and jargon which characterize
the medical writings of the  day,"  is  at  least
offensive, if not arrogant, and while it partakes of
the humbug so liberally condemned, it points to
the " hen-egg"—the alpha and  omega instrument,
which is, or ought to have been, fully described
in Fox's  Book of Martyrs.
   Such at least is the inference to be drawn from 
V
 the work, and as  its therapeutic  advantages  are
 rather  obscure, it is  plain that another object,
 than the instruction of youth, has controlled  the
 mind of the author.   Instead of testing and  re-
 sorting to the remedial agents  that are based upon
 the anatomy and physiological laws of the tissues,
 he classes all in the category, and condemns in
 the lump the  good with  the bad, leaving only
 his favorite, as worthy the attention of the profes-
 sion.   But as my instrument is not a compound, or
 a nostrum, but a peculiar bandage, a mechanical
 agent, that  has been  adjusted with  care, I  ask
 only the consideration that is due to its merits.
 If it is worthless, condemn it • but for the sake of
 suffering humanity, let it not be rejected on a silly
 hypothesis,  or  condemned upon absurd anato-
 mical reasoning.  In the hands  of many of the
 distinguished physicians of the city, it  has  been
 singularly successful, and without " their recom-
 mendation in the  newspapers," it continues to
 relieve  their  patients, and receive  the appro-
bation of the  public.  The author, however, of 
VI
the " six hundred and sixty pages" in his letter
to his friend says,  "shall people who  desire to
make a contribution to the art that has absorbed
their whole  existence,  refrain  from doing so
from a fear of  offending in  the  matter of their
manner ?  Would that be American like ?  And
shall they go out of the world making  no sign ?
Beaufort was asked but to hold up  his hand, but
he died and made no sign,"  But on reading the
work, will it not be the impartial opinion of the
medical profession,  and the public generally, that
it would have been better for the author's repu-
tation, had he, like the cardinal, died and made
no sign. 
              A REVIEW
                    OF
"FEMALES AND THEIR DISEASES."


  Dear Sir—As you are unacquainted with the
principles that gave rise to the construction of
the  instrument placed in your hands, and as  it
will be necessary sometimes  to sustain it with
those whose theory enables them " to reason phy-
siologically and yet mean nothing," I must draw
your attention to  some anatomical facts  that
make it an important remedial agent in the treat-
ment of the various diseases for which it is re-
commended.
  Having watched the  progress of the age, and
diligently applied my mind to the improvements
that became  necessary  in practice, I observed,
as many others  had done before  me, that the 
8
diaphragm  was  a complete  movable  septum,
placed between the thoracic and abdominal cavi-
ties ; that it was extremely  concave below, and
convex above, the  lower cavity  being occupied
by part of the abdominal viscera.  This septum
converging, as it does, from the circumference of
the thorax, an acquaintance with its  anatomical
structure  is highly important. On each side of the
cordiform tendon the muscular fibres rise so high
before they join it, that their horizontal level is in
a line with the anterior end  of the  fourth  rib.
Thus you will  perceive that  its  form is nearly
circular.   It  is fleshy at its circumference,  and
aponeurotic in the  middle.   Anteriorly, it is at-
attached  to the  ensiform cartilage ; laterally, to
the internal surface of  the  cartilages of the six
last ribs ; posteriorly, to the transverse  processes
of the first lumbar  vertebra; by its left  pillar, to
the bodies of the three first vertebra of the same
region, and by its  right pillar, to the  bodies of
the four first.   Consequently, the structure of
the diaphragm  consists, in part, of a  three-lobed 
9
aponeurosis,  termed the  Phrenic Centre.  The
upper surface is connected with the pericardium,
the mediastinum, and the  pleura.   Its lower sur-
face, posteriorly, is in  contact with the kidneys,
the  suprarenal  capsules,  the pancreas, and  the
duodenum, on the right side with the liver; and on
the  left, with  the spleen and stomach * in the
whole extent of the lower surface, it is covered
by the peritoneum.  In the mechanism of respi-
ration, the  diaphragm performs a most important
office.  In coughing,  vomiting,  laughing, and
speaking, it is alike a principal agent, and  assists
in various functions, such as the expulsion  of the
contents of the intestines,  the bladder  and the
uterus.   The next object  in connection with the
subject is the peritoneum.   " This is a thin, deli-
cate, semi-transparent  membrane, very extensive
and  spread out  so as to line  the  cavity of  the
abdomen, and to give an external covering  to the
greater  number of its  viscera.  In  men it is  a
complete sack,  having no  opening  in  it;  but
in women, its  cavity communicates externally
  1* 
10
 through the fallopian tubes."  It has a two-fold
 use : the first is to cover the viscera and tie them
 down  to  the back  and sides  of the abdomen;
 the  second is, in consequence of covering the
 viscera, so reflected to the sides of the abdo-
 men that  its processes keep the viscera in their
 proper places, and consequently act as ligaments
 to the  organs contained within the cavities of the
 abdomen and pelvis.  The liver is fastened in its
 position by the following  reflection of the peri-
 toneum.   From the centre  of the  diaphragm,
 and extending from  the umbilicus backwards, to
 near the ascending cava, are the falciform, or sus-
 pensory ligaments.   The  round  ligament,  the
 right  lateral  ligament, and the  portion  of  the
 peritoneum concerned in the union of these, form
 the coronary ligament, &c.
   Thus, you see, that the peritoneum, by its liga-
ments  and reflections, not only suspends the liver
to the  diaphragm, but is  so adjusted  as to give
the necessary attachments  to  the greater number
of the viscera contained within that cavity. 
11
  Having thus examined the ligaments and reflec-
tions, that sustain the viscera of the abdomen, you
will next direct your  attention to the  ligaments
and reflections that sustain the organs of the pelvis.
The ligaments  of the bladder are the urachus,
which  proceeds from the upper end to the navel,
forming a long conical ligament, and on each side
of this  ligament, are the remains of the umbilical
arteries of the foetus, which are called the round
ligaments of the bladder.  Besides the above three
 o
ligaments, it  receives a complete  coat from the
peritoneum, attached  to the upper and posterior
parts, and passing  thence  to the  muscles of the
abdomen, before, and to the uterus behind, it forms
the anterior ligament.
  The uterus is a compressed pyriform body, with
a cavity in its centre, and is placed between the
bladder and the rectum, with the small bowels
above,  and the vagina below.  Professor W. E.
Horner says, " it is maintained in its situation, in
the centre of the pelvis, by the reflections of the
peritoneum, which are  called ligaments."  The 
12
peritoneum, after covering the uterus completely,
is reflected  anteriorly upon the bladder, and at
each side of this, is a reflection of the membrane
denominated the anterior ligament, which goes to
the urinary organ.  The peritoneum in passing
from the back part of the uterus to the vagina,
and rectum, has on each  side of the reflection,  a
duplicature, which constitutes the posterior liga-
ment.  It is also reflected from the whole length
of each side of the uterus, to the corresponding
part of the cavity of the pelvis. These reflections
are the lateral, or broad  ligaments, which, with
the uterus, form a transverse septum in the middle
of the pelvis.  Besides the  ligaments mentioned,
the uterus has two more, one on each side, called
the round ligaments.   They arise from  the sides
of its body, between the duplicatures of the broad
ligaments, and pass under the peritoneum, to the
abdominal ring, through which they pass, and are
lost upon the fat of the mons-veneris and the labia-
majora. They are of a fibrous structure, and have
many blood  vessels in them. 
13
  Having finished this view of the  diaphragm
and peritoneum, in connection with the viscera
of the abdomen and pelvis, I will now proceed to
present what I consider as the results of such an
organization.
  The form of the diaphragm, which is a conical
arch, and made up from suitable origins, was  de-
signed to have great strength for the performance
of its functions in the healthful state. Every time
we  draw our  breath, it contracts, and changing
its vaulted form to that of a  plane, it  enlarges the
capacity of the chest,  so as  to permit the dilata-
tion of the lungs.  At  the same time it forces the
viscera that are loosely attached, downwards, and
the muscles of the abdomen outwards, and it is,
consequently, the principal muscle of inspiration ;
on the other hand, when it relaxes, the abdominal
muscles press their viscera upward, the diaphragm
is pushed up in the  thorax, is made to compress
the lungs,  and  thus   contributes  to expiration.
These movements are anatomical and physiologi-
cal, and, in examining into causes, that  produce 
14
debility in any of the muscles of the abdomen or
alteration in  the  peritoneum, at its processes or
ligaments, we may inquire  what it  is that pre-
vents the bowels from descending into the lower
portion of the abdomen or cavity of  the pelvis 1
What barrier has the pelvic viscera  against the
encroachment of  the viscera of the  abdomen?
This question I proceed to answer.  The anatomy
of the parts shows that the line passing around the
pelvis, on a  level with the promontory  of the
sacrum, is the narrowest point in the pelvis. The
psoas-magnus, the iliacus, and  obturator-internus,
passing over, and part of them having their origin
within the pelvis, assist in narrowing  this boun-
dary still further.   Hence it is seen, that this part
of the  bony and fibrous structure, with the  ad-
mirable arrangement of the peritoneum, in giving
a coat  to the uterus, and by the broad ligaments
attaching  it to the walls of the cavity, there is
formed another arch, or floor, below as an anta-
gonist to the diaphragm above.
  The  round ligaments being of the same fibrous 
15
structure as the uterus, about the size of a  goose-
quill, proceeding from the sides of that organ, and
passing out through the abdominal ring, to  be in-
serted  into  the  mons-veneris  and labia-majora,
are governed by the same physiological laws  as
the uterus itself; whilst the uterus is  in its unim-
pregnated state, these ligaments have but little in-
fluence, but so soon as that organ is impregnated,
and commences its growth and ascension, we then
find them by increased nutrition, increased in ten-
sion and augmented in length, as required, and
enabled, during the ascent of the uterus, to main-
tain it in contact with the  anterior walls  of the
abdomen.   Thus, as soon  as the term of gestation
is over, these ligaments and uterus contract upon
themselves, until each is reduced to its unimpreg-
nated condition. They are also the support  which
prevents the weight of the  uterus, with its  con-
tents, by maintaining  it  in  its proper position,
from deranging the organs of digestion.
  But a recent writer on  Retroversion, in sundry
letters to  his  pupils, says:  " It is a diseased or 
16
debilitated state of the round ligaments that gives
rise to the disorder."  " The cure," he continues,
" consists in the restoration of  the  health and
tone of these ligaments."
  The scalpel, however, with the analysis of the
tissues, and the observations of the various writers
on anatomy, show that this hypothesis is not sus-
tained, and  that  the  author  has  entirely misap-
prehended that it is the  reflection of the perito-
neum, including the ligamenta-rotunda, that pre-
vents retroversion, and not the round  ligaments.
  The following cut of the uterus with its peri-
toneal coat removed, presents the  muscular fibres,
marked b b on the external surface of the uterus,
terminating  in the round ligaments marked a a.
This drawing fairly demonstrates the character
of these  ligaments and  the offices they are in-
tended to perform. 
17
  Blundel says,  "The round ligaments, two in
number, originate from the superior lateral parts
of the  uterus.  They run into  the doublings of 
18
the broad ligaments, and, rising to the brim of
the pelvis, pass over it, through  the  abdominal
ring,  and  lose  themselves,  as it were, in the
mons-veneris and the groins.  They are composed
of arteries, veins, lymphatics, nerves, and fibrous
structure united together by  cellular membrane.
Though small in the unimpregnated  state, they
become developed by gestation, lengthen, spread
and are more vascular.''
  Our author alluded to, is likewise frightened at
a " remedial agent called a Supporter," and not
in the language, but in imitation of Hamlet, calls
upon  his students to  look upon "the grim  and
ghastly  representative of our  poor mortality,"
and follow him through the denunciations he has
" extracted from his brain" to expose the  indis-
cretions of his brother professors.   " Do 'nt you
see," he exclaims, " that if you draw a line from
the pubis to  the xyphoid  cartilage, it will repre-
sent the  linea alba of the  grim horror ?   Look
again  and observe the  place where  the mesentery
was attached, and the root  of the meso-colon 
19
too?"   Yes,  my  young friends, look again and
again, and examine for yourselves the linea alba,
made up from the tendons of the muscles and
fasciae of the abdomen.  Look at the origin and
insertions  of the  two obliqui  externi, the  two
obliqui  interni, the two transversales, the rectus
abdominis, the two pyramidales, and the serratus
magnus, and make yourselves familiar with their
several  offices.   Look  and admire how wonder-
fully they assist respiration, sustain and compress
the viscera of the abdomen, and antagonize the
force of the diaphragm.  Look also at the uterus,
and contemplate the relative parts placed by the
God of  nature for its support.  These attentions
and  practical  observations will tell you  that
where the muscles become debilitated  by child-
bearing, or other  causes, they have need of  sup-
port, not only from the remedial agent so much
abused,  but  from  all the  remedies  brought  into
use since the time of Esculapius.   It is, indeed,
true, "we are fearfully and wonderfully made*"
but were we to follow the doctrines of the worthy 
20
professor, with  his uterus perched upon the va-
gina, we should have the best reasons in the world
for alarm.   But as the work contains much that
is foreign to the subject, we must look upon the
fathers of the science, who took nature for their
guide, and derived the information  that was cal-
culated  to mitigate  the affliction  of  the  human
family.   If he  had even looked  into Pope the
text  is made out to his hand, and instead of draw-
ing upon fancy or  the credulity  of his  pupils,
much might have been saved to his readers.  This
writer says:
    " First follow nature, and your judgment frame
    By her just standard which is still the same ;
    Unerring nature, still divinely bright,
    One  clear, unchanged, and universal  light,
    Life, force and beauty, must to all impart
    At once the source, and end, and test of art."
  But that  his "brother  anatomists"  who have
"paraded their  names in  the newspapers," and
those interested, may  contemplate his incompar-
able  arguments, the following  extract, from page
188, will  answer:—"Now,"  says the  writer 
21
" take a utero-abdominal supporter, and adjust it
as the mesmerized do, mentally upon the skeleton,
and you will see that it can have no effect to hold
up the bowels;  that it can only push your fancied
tractus of the linea alba backwards  against the
spinal column; and  with what  effect,  pray?
Surely, with none other than one of encroachment
on the capacity of the abdomen.  Do you not see
that  the  belly  of a living  man or  woman  is a
vacuum plenum ?   How can you hold up  the
bowels by a pad ?  If you  could thrust them up-
wards in  the vacuum plenum, which you cannot
do, you would only thrust them towards the con-
cave of the diaphragm.   But the diaphragm must
come down, or the woman will die—she can't
breathe  but  by the descent of her diaphragm.
Her diaphragm is her respiratory piston, and the
trunk of the body  is the cylinder in which  this
piston moves downward in the aspiration, and up-
wards in the expiration of the air  of the atmo-
sphere."
  But here, you will observe, although the argu- 
22
ments  are forced and contradictory, that if the
parietes of the abdomen are  " forced backwards
against the spinal column,"  as  he tells you, it
must follow that the viscera of the abdomen must
be prevented from encroaching upon the organs
of the pelvis,—the  very mischief that  is to be
overcome.
   " But your utero-abdominal supporter," he con-
tinues, "knows better than the Providence  that
made this great machine; and he is about to make
the piston work half strokes in breathing; like an
engine that  one  is  afraid of."   Half strokes in
breathing! This, gentlemen,  might be true;  but
where can you find the practical engineer,  who
would apply a half force where no force is want-
ing ? Would he not  exhibit his judgment by  con-
fining his piston within in its proper limits, and
guard against over or under action ?
   Our author has also forgotten the comparative
weight of the various organs  that are  dependent
for their support upon the  peritoneum, and of
 course has reversed  the principle that invariably 
23
   governs the practical anatomist.  The weight of
   the liver is forty times greater than that of the
   uterus and its appendages, and when we  look at
   the two organs, and their fixed points of attach-
   ment, the anatomist will discover that the uterus
   is more secure than the liver, and, consequently,
   the  relative supports of  the  organs  are  at least
   equal.  But as the  work is considered ephemeral,
   intended only for a class  in the rudiments of the
   study, it is not presumed that the works of his
"   distinguished cotemporaries will suffer by its pub-
   lication.
      On prolapsus uteri he is alike emphatic, and
   without qualification maintains his position.   He
'   says, " prolapsus uteri is  a disease  of the vagina,
   not  of the womb.  To  cure prolapsus uteri, you
!   are  to seek to cure the vagina, and when you
    have  done that  the womb will be  found  cured
    also." This declaration, when traced to its source,
    is incredible.  To me " 'tis passing strange!" that
    one  of the  most important  organs, designed by
    Almighty  God  for "replenishing  the  earth," 
24
should be propped  up by  so  feeble a support as
the  vagina.   But, in  order to  determine the
validity  of such doctrine, let us take a cursory
view of  the vagina, in connection with its  re-
lative parts.   The  levator-ani  muscle  is  very
thin, and by  its attached portions  it acquires
a funnel shape, and has two-thirds of its  fibres
inserted  into  the circumference of  the rectum.
The  remaining third,  into  the  bones of  the
os  coccygis,  the  vesicle end  of the  urethra,
prostate   gland,  and  the  point  of the  perineal
muscle.   The  triangular ligament, when under-
stood in  its relation  to its several attachments,
and its  connection with  this  muscle  and  the
aponeurosis pelvica, it will be seen that the  le-
vator has a double office to fulfil.   The first, is to
draw up the rectum after the contents have been
removed  or expelled;  the second, to assist  the
sigmoid  flexion of the colon in sustaining  the
contents  of the  intestines which  are made by
the peristaltic and vermicular motion to  Gravitate
to  the  natural outlet;  otherwise, the  rectum 
25
 would be under the constant solicitation to part
 with  its contents.   The coccygis is a thin, flat,
 triangular muscle, attached to the spinous pro-
 cess of the  ischium.   Its fibres diverge, and are
 inserted into the border of the os coccygis*  it
 secures this bone in its station. The sphincter-ani
 muscle is of an oval figure, open in its centre,  its
 fibres surrounding the extremity of the rectum, or
 anus.  It is attached to the os coccygis, by a species
 of cellular tendon, from whence two fleshy fasci-
 culi proceed, uniting together in front of the anus.
 The upper surface is connected with the levator-
 ani by a cellular tissue.   This muscle closes the
 anus, and, in the male, draws down the bulb  of
 the  urethra.   The ischio-cavernosus  is  a small
 elongated muscle, placed along the ramus of the
 ischium, and the root of the corpus cavernosum
 in the male.  This  muscle terminates  in the fe-
 male, by embracing the corpus cavernosum of the
 clitoris.  The transversus perinei is  a flat, thin
muscle, attached on its outer part to  the ramus
and tuberosity of the ischium—on the inner part
   2 
26
to the middle line, with its fellow on the opposite
side.  This muscle supports the lower part of the
vagina,  rectum,  and bladder.   The  constrictor
vagina  consists of a number of muscular fibres,
forming a sort of broad fleshy ring, surrounding
the vagina.  This muscle contracts the part which
it embraces, viz: the  labia externa and interna
or nymphse, the clitoris, and  the vestibulum, the
fourchette, or frenum vulvae, and the  hymen  in
the virgin state.  These, with the above named
muscles, are found within the region of the pelvis
and vagina, and their uses and purposes are  fully
described in any of the  anatomical works.
   Professor W. E. Horner says:  " The vagina is
the intermediate part  of the sexual organs.  It
extends from the vulva to the uterus, being placed
between the bladder and rectum,  compressed an-
teriorly, and posteriorly, by them.  It is a mem-
branous  canal, of from four to  six  inches  in
length,  differing according to age and pregnancy,
being much shorter in  women who have borne
children than in virgins;  its shape varies somewhat 
27
 near the vulva; but its greater diameter is verti-
 cal ; behind, near the uterus, the greatest diameter
 is transverse;  its anterior and posterior surfaces
 are in contact, from the circumstances just men-
 tioned, of pressure  between the bladder and rec-
 tum ; it is shorter before than behind, correspond-
 ing in this respect with the pelvis by which it is
 influenced, and also in  consequence of being at-
 tached to the uterus higher up on the sacral than
 on the pubic side.
  " The peritoneum, in  descending  from the
 uterus anteriorly, touches  the top  of the vagina
 for  a little distance, and is then  reflected to the
 bladder; but posteriorly, nearly the upper half of
 the vagina has a peritoneal coat, before this mem-
 brane is reflected to the rectum.  The attachment
 of the vagina to the bladder is  strong  and  close
just above the urethra, but its connection to the
 rectum is by rather loose cellular membrane.
  " It consists of two coats, a fibrous and elastic
 one externally, and a mucous one internally.  The
 first is of a reddish  color, and  seems to be formed 
28
 of  condensed cellular  membrane, its fibres  not
 passing in any determinate direction;  many blood
 vessels are found  in  its structure, and it  has an
 abundance of large venous sinuses surrounding it."
 From a survey of the anatomical structure, and
 from my own observations in dissection, I wholly
 dissent from the author of the  forty-two  letters,
 whose opinions I am  reviewing, and  am clearly
 of the opinion  that, instead of the vagina sup-
 porting the  uterus by its attachments to  that
 organ, it imparts  to  it but little  strength, and
 receives its  own support  from the  connection
 with the peritoneum.
   Such being the  fact, and when we consider
 the  object and  offices of the  several muscles,
 membranes, &c, of this department, in what pos-
 sible position can  we place them, to represent
 the  " pelvic  floor" of the worthy professor ?  If
 his position is right the anatomy is wrong,  and if
 prolapsus  is  a disease  of  the vagina, then is  he
wrong in  his therapeutics, and how can he ex-
claim to his  pupils "cure  the  vagina and you 
29
 cure the disease ?"   But from the facts before us,
 would  it not be better or more in accordance
 with the science, and his own pathology, to have
 regulated the bowels by aperients and alteratives,
 by simple  and medicated  enemas, by alum and
 water  to  restore the  tone of the  levator  and
 rectum, to meet and resist at the proper point
 the superincumbent weight of the viscera of the
 abdomen, and by the use  of  cold  water in the
 vaginal membrane, with astringents and styptics,
 according Avith the pathology of the parts, rather
 than divert his pupils with  an insufficient prop to
 the uterus, or force upon the profession an  ima-
 ginary floor, that is not sustained by the anato-
mical arrangement.
   By my  experiments  on the dead  subject, I
have found after removing  the vagina and leaving
the uterus with its peritoneal attachments  and
round ligaments only, a considerable weight was
necessary to force it from its position.  This fact
was realized by the dissection in  two different
 ways.   The first by  removing the lower portion 
30
 of the  os  coccygis  with the same extent of the
 rectum and vagina,  leaving the fourchette entire.
 This brought in view the  uterus in its proper
 position, with the  upper  portion of the vagina
 and its attachment to the uterus and peritoneum.
 The  second,  by removing  the vagina with half
 the portion of the perinei muscles and fourchette,
 so  as not  to  interfere with the  rectum.   These
 modes of dissection  enabled me to determine the
 amount of support  the  uterus derived from the
 vagina.  By  making a  transverse section  from
 one ilium  to the other, and by removing the
 upper portion of the walls of the abdomen to the
 sternum, and  cartilaginous portion of the ribs, I
 was enabled to judge of the support the ligaments
 give to the organs of the pelvis.  Then placing a
 block under the subject at the lumbar region, the
 anterior part  was put  on  the stretch,  and the
 bowels being  thrown upwards, the  organs were
 brought clearly into  view.   The  hypogastric and
inguinal region  being now made tense,  by the
tenaculum, the urachus and round ligaments dis- 
31
sected  away, to expose the upper portion suffi-
ciently to enable me to hold those with a forceps,
(the bladder  being  inflated in order to represent
the distension brought on by retention of urine) I
could then ascertain the degree of pressure, ex-
erted  upon  the  uterus  in different  directions?
and determine  the strength of the  ligaments
when  put on a stretch in the  various displace-
ments of that organ.  I admit that the disease of
the one may  affect the other, but that the cure of
prolapsus  is  solely  dependent upon the cure  of
the vagina is a gratuitous assumption, sustained
neither by facts nor argument.   On the contrary,
I contend that the  uterus is  sustained in its  ap-
propriate  situation  by the broad and round liga-
ments, aided by the utero-vesical and utero-sacral
ligaments; and  that while these ligaments retain
their healthful tonicity, the uterus could not  de-
scend, even if the alledged vaginal  support were
removed  by the scalpel.  Besides, should these
ligaments become relaxed, the uterus will descend
not only into the vagina, but pass through it, and 
32
hang outside of the vulva.  Churchill says, " it is
produced, first, by a relaxation of the broad and
round ligaments above ;  second, by a want of due
tone in the vagina below. By the first, the uterus
is permitted to fall, and by the second, the uterus
is allowed to be received into the cavity.  Such
being the state of the parts, it is clear that a very
slight downward forcing will depress the womb,
and ultimately exclude it from the vaginal orifice.
This  force  will  be supplied  by the increased
weight of the uterus, if the patient sit up or walk
soon after delivery or  abortion."  What value
then can we attach to this flimsy vaginal support ?
None.  Is it not the chimera of a vacuum plenum
brain ? But what medical man can read such anti-
chirurgical and anti-physiological nonsense with-
out feeling ashamed of his cloth.
   Furthermore, if the antagonistical point against
the action of  the diaphragm  is made up by the
levators, the sphincters, the vagina, and the other
muscles  forming the  perineal floor below, it  is
 equally clear  there would not  be one  displace- 
33
 ment where  there  are  now one hundred,  if it
 were not for the superincumbent weight of the
 viscera of  the abdomen  and the  force of  the
 diaphragm.  The diseases of the organs contained
 in  the  cavity  of the pelvis, are so  closely  con-
 nected, that the displacement of any  one deranges
 the others.  The uterus being displaced, frequently
 compresses  the rectum and bladder.  The  rectum,
 overloaded  and  distended, deranges the uterus
 and vagina.  Over distension of the bladder  dis-
 places the uterus, and  produces prolapsus of the
 vagina, which is one of the  fruitful  causes of
 leucorrhcea.  Prolapsus uteri may  consequently
 be considered the most frequent, as well as the
 most troublesome  disease to which the female is
 liable.
  Dysmenorrhcea, the next in order, is  a  disease
 extremely harassing, and  depending upon  like
 causes.—During the menstrual  period of life, this
derangement in the functions of the uterus, is the
principal  cause of the sterility that most generally
afflicts those who are possessed of an irritable
  2* 
34
lymphatic  temperament.   From close attention
to the history of each case treated by me, in the
last five years, the following is  the view I have
taken of the pathology, drawn from the symptoms
of the disease.  These  are, a sense of  fullness,
tension, and pain  in the  pelvis, loins, and back,
with an accelerated, quick and tense pulse, a hot
and flushed akin, a strong manifestation of inord-
inate excitement,  and congestion of the uterine
system.  In certain cases the febrile symptoms
are less violent, owing to peculiarity of constitu-
tion, or impaired general health.   Hence it is to
be inferred that the organ is first depressed on the
vagina, either directly or indirectly.   This, too,
arises when the functional derangement has been
produced from  cold, giving rise to an increased
fullness of the organ, and a consequent tendency
to  sink  into the  vagina.  This is the indirect
form of the  disease, but  the more direct causes
 may be traced to the superincumbent weight and
 force, acting from above.  The organ being thus
 displaced, its surface is brought in contact with 
35
 new parts, which act on it  as a foreign body, es-
 tablishing  in its tissues a  degree of irritation,
 which invites a greater afflux of blood to the parts,
 and which is much increased at each catamenial
 period,  amounting often to a sub-inflammatory
 action.
   Thus, it seems to me, that the controversy be-
 tween various writers, on inflammatory and non-
 inflammatory action, is only reconcilable on  the
 following grounds.   At the time of the periodical
 flow, the organ, or  its lining membrane,  is under
 the influence of inflammatory action, and, during
 the interval, it is  in  that chronic, or sub-acute
 form, which constitutes the  condition spoken of,
 as being a rheumatic affection.  In the formation
 of the pseudo-membranous  substance, that often
 is  discharged, it is  evident that an  inflammatory
 or highly irritable  state of  the parts must  have
 existed previously.—In this, I am sustained  by
 Hunter,  Mackintosh,  and Eberly, and when the
 menstrual action of the uterus is morbid and de-
ranged, it is sufficiently obvious to  any one, that 
36
 the structure of the organ is in a morbid condition
 in some of its tissues.   Hence  a depressed uterus,
 with its os uteri resting upon the vaginal floor of
 the perineum, with the weight of the viscera of the
 abdomen resting upon  its  fundus and ligaments,
 must necessarily produce retroflexion, or antiflex-
 ion, and  consequently  form an angle, or bend in
 its cervix.   This, with the entire  organ resting
 against new  parts, acting upon it as a foreign body,
 what cause or causes are better calculated to pro-
 duce dysmenorrhcea ?
   But in this suggestion, it is not to be understood
 that they are  the only  causes  of the  disease.
 Some  cases, though  few, are  congenital,  and
 others may have been the result  of a morbid  ac-
 tion.   In pathological anatomy  it  is understood
 as a principle that when " a mucous canal comes
 to be traversed by a less quantity of the fluids to
 which it  gives passage, it undergoes a more or
less  considerable  contraction;  on  the  contrary,
however, when the fluids are more abundant than
usual, the mucous membrane becomes much dilated, 
37
and recovers but  slowly its primary dimensions
after the cause of its distension ceased to act."
The former  of these  pathological  changes may
account  for  Dr. Mackintosh's cases treated  by
dilatation; the latter  should admonish us to use
no  remedy that would produce fluor  albus.   In
my practice I have found nineteen  cases  out of
twenty of my  patients, laboring under  dysme-
norrhoea, with the uterus too low in  the  pelvic
cavity, and have  invariably removed this irri-
tating  cause by the application of the supporter,
with such other remedies as the pathology of the
cases required.  In this position I am sustained
by Professor Meigs himself, who says, " a womb
that is maintained at its proper height, and in its
proper attitude in the pelvis, will be, coderis-
paribus, less  likely  to  be  subject  of  dysme-
norrhcea."   He also, in  a second sober thought,
appears  to  have  discovered the secret of mis-
placement, and says,  "that  the  os  tincse rested
upon the floor of  the  pelvis, where it had long
rested; and  I  supposed that the weight of the 
38
uterus and the superincumbent pressure had pro-
duced an anti-flexion of the cervix."  That  dys-
menorrhcea should have continued so intractable,
and the action of remedies so very unsatisfactory,
is  not to be wondered at, since the  cause  is
constantly in  action.   The uterus is composed
of a dense fibrous substance, covered externally
by the peritoneum, and  lined through by a  mu-
cous membrane, which is  continuous  from the
vagina, throughout the  entire organ,  into the
fallopian tubes;—along which it extends to their
fimbriated extremity, where it becomes  continu-
ous with  the peritoneum—thus, presenting a
singular example of the continuity of a mucous
and serous membrane, with  each other.   To this
anatomical arrangement, and known physiological
law of the tissues, is to  be  attributed the  failure
of the pessaries in prolapsus.—Yet the  author  of
"Females and Their  Diseases," even in this en-
lightened  age, recommends  them to his  students,
and says, " that only weak people and quacks  pre-
tend to scorn  them."  But, in the next pa°*e, I 
39
 suppose, after having considered the pathological
 condition of the parts, and the modus operandi of
 the instrument, he says, " I detest the pessary as
 a disagreeable and  disgusting thing, whether to
 order or to wear.—I  will never employ one ex-
 cept where a conscientious regard to the sanctity
 of the interests  committed to my care  seems to
 render it indispensable."
   Burns, however, in  speaking of dysmenorrhcea,
 says, "this state of the womb sometimes pro-
 duces, besides  uterine pain, spasmodic affection
 of the bowels, or violent bearing down efforts  of
 the abdominal muscles, as if it were intended to
 expel  the womb  itself.  Such efforts  are  also
 sometimes made  periodically, when the  menses
 are  altogether or  nearly  obstructed."   Which
 very clearly shows the necessity of some kind of
 bandage or support,  to overcome the spasmodic
 affection of the abdomen.
  The cure of these  displacements—Prolapsus,
 Procidentia, Retroversion and Antiversion—con-
sists in removing the  cause, or causes, and in mak- 
40
ing an artificial floor to resist the weight and pres-
sure from above.  This is accomplished by the
application of pressure at the exact point where it
is wanted.  Then by the administration of the ap-
propriate  medicines, according to  the  symptoms
of the disease, by the use of moderate exercise in
the open air, and by sponging the body with cold
water in  the morning, when not forbidden by
organic disease; or, when  it  interferes, wash
with  warm whiskey and water, or  salt and water.
Where  the  disease is produced by child  bearing,
friction may be  resorted to.
   The causes and remedies being now understood,
there remains to be considered the character and
value of the remedial agent placed in your hands.
The  instrument, you will observe, differs in its
object from those which have been denominated
uterine supporters.   It is not designed  to support
the uterus directly, but to support the viscera of
the abdomen, which, by their weight, bring on a
displacement  of that   viscus.  It is  also easily
fitted to the parts, and, by the peculiar  arrange- 
41
  ment of the pad, being full at the lower boundary,
  a backward and  upward  pressure is made upon
  the inguinal region exactly  in a line correspond-
  ing with the junction of the ilium to the sacrum.
  The recti muscles are avoided,  and the springs
 being permitted to traverse  the pelvic bones,  of
 course we escape the  muscles that are calculated
 to remove or displace the  instrument.
   The practical advantages it is my intention to
 place in the hands of the Profession.  The time I
 have spent in dissection—in experimenting upon
 various forms, and in  endeavoring  to make the
 improvement both useful and desirable, has been
 tedious and expensive.  As  a remedial  agent, it
 would be of little value, if thrown into the hands
 of the various manufacturers  without the  control
 of the inventor.  Like  our instruments in surgery
 —in dentistry—in the  various machines  for the
 »elief of the human family, it would become an
 article of merchandize, and  its value  would be
lost to the profession.   You  will, therefore, en-
deavor to preserve its original shape, and place it 
42
where the profession and the druggist can obtain
it on the same terms as any of the other remedial
agents.
  Such, therefore, being the facts in relation to
the nature and  cure of the uterine diseases, al-
luded to above,  it is plain that this instrument,
tending to relieve the pelvic organs of the weight
of the  abdominal viscera, when in an upright
position, must be of importance, and in its appli-
cation, I have experienced the  most satisfactory
results.
   Having thus considered  all  that I  have to say,
in relation to the remedial agent now before the
public,  and, having  replied to  the arguments so
wantonly urged against it, it is only necessary to
recapitulate the views I entertain upon the sub-
ject.—In the human economy, it is well known,
that the various organs are so arranged, as to  be
subservient to each  other,—that each, by the ar-
rangement of the elements of  which  it  is  com-
posed,  is possessed  of organic  life,  and  by the
harmonious action of the whole, animal life is at- 
43
tained, health is secured, and  each organ within
the economy is enabled to perform  its specific
function—When a failure  takes place in any of
the organs, we know it must result  from some
definite cause or causes;  but whether  they are
chemical  or  mechanical, it is certain that a re-
moval of  the cause is necessary before  the  cure
can be effected.   I, therefore, contend—
  First. That the uterus is sustained by its  liga-
ments, and not by the vagina.
  Second. That the round  ligaments  are  not the
only support that prevents  the uterus  from being
retroverted;  but that  portion  of the  peritoneum
which overhangs those ligaments and the utero-
vesical septum, are  the chief reflections that pre-
vent retroversion.
  Third.  That the  uterus  must first be elevated
and  somewhat  enlarged  before it can  be retro-
verted, or its fundus  must  be forced below the
promontory of the sacrum, before retroversion can
take place.
  Fourth. That  prolapsus,  procidentia,  retrover- 
44
 sion, anti-version and flexions of the uterus, are
 owing to a relaxed or weakened condition of the
 ligaments of the uterus, and  the super-incumbent
 weight of the viscera and force of the diaphragm.
   Fifth. It seems to me, that this writer, upon
 "Females and Their Diseases," resulting  from
 misplacements of the womb, has lost sight of one
 of the most important elements in the pathology of
 those cases—and that is the state of the ligaments
 which are attached to, and within the pelvis, that
 support the womb.
   He ought to have observed and remarked upon
 this important physiological  law, viz: that the
 diaphragm has an antagonistical force on the floor
 which is formed at the upper marginal brim of
 the true pelvic cavity, and where  this floor re-
tains, together with the  muscular parietes of the
abdomen, its full power and energy, there can be
no  displacement  of the  womb.   The  repeated
distension of the muscles of the abdomen, during
the term of gestation, and  the debilitating causes
attendant on constipation of the bowels, with their 
45
 frequent over distension with gas, cannot but tend
 to  debilitate  those  parts, and  overcome their
 powers of resisting the bearing down force of the
 diaphragm;—and as the womb depends for its sup-
 port on the firmness of the tissues composing its
 ligaments, it is clear to  my mind, that  it will
 be carried down, by the loss of power in the one,
 and the force of the other.  Hence, it is evident,
 both by reasoning on, and by observing clini-
 cally,  the facts, in the  displacements  of  that
 organ, that the weakness and loss of power of the
 muscles of the abdomen, and the ligaments of the
 womb, have much to do with the  pathology of
 those displacements of the uterus.
  Sixth.  "That  long continued tenesmus, con-
 nected in its origin with  costive condition of the
 rectum," and which  the  author asserts produces
 shortening of the vagina, I regard as the causes
which call into action that powerful muscle, the
diaphragm, and  produce displacements  of the
organ.
  The principles which have governed my con- 
46
duct in relation to the medical profession I think
it is not at this time  necessary to give in detail.
In my intercourse I have claimed no superiority,
nor  have I urged  empirical pretensions to their
notice.   Like  the author,  whose  book  I have
partially noticed, I have thought " the honestest
way  for a  man to speak  is, to speak what he
thinks,  in his own tone and manner, and not to
come before the public under  a false disguise."
The instruments I have  constructed, have ever
been tested,  before  they  were placed in the
hands of the Profession, and, in securing a patent
for the  one in your possession, I have only, like
the author of a book, secured to my  family the
profits of the manufactory. 
s*