PNEUMATIC PRESSURE 
AND THE 
GENU-PECTORAL POSTURE 
IN THE 
REDUCTION 
OF 
Uterine Luxations. 
BY 
A. SIBLEY CAMPBELL, M.D., 
AUGUSTA, GEORGIA. 
Reprinted from the American Journal of Obstetrics and Diseases of Women 
and Children, Vol. X., No. I., January, 1877. 
NEW YORK: 
WM. WOOD & CO., 27 GREAT JONES STREET. 
1877. With Compliments of 
PNEUMATIC PRESSURE AND THE GENU-PECTORAL POSTURE 
IN THE REDUCTION OF UTERINE LUXATIONS. 
A REPLY TO DR. DOUGHTY'S " INTERROGATORY." 1 
BY 
A. SIBLEY CAMPBELL, M.D., 
Augusta, Georgia. 
(With five woodcuts.) 
In the October number of the American Journal of Obstet- 
rics an article appeared, which was chiefly occupied in review- 
ing the opinions of Prof. Henry F. Campbell on this subject; 
and which at the same time failed to present fairly his teach- 
ings, either as to the action of forces, or the applications of the 
method in practice. 
As a wrong impression may have been inadvertently con- 
veyed to the readers of the Journal-by means of detached and 
fragmentary quotations, and by giving undue prominence to 
the expression of some of his opinions, while other qualifying 
clauses, no less important, were forgotten or disregarded-being 
familiar with the views of Prof. Campbell, and knowing by 
my own experience the great value of this method of treatment, 
I shall in the following discussion briefly refer to his already 
published paper,2 and consider also the validity of Dr. Doughty's 
adverse arguments. 
In " the interrogatory " contained in the very title of this 
review there is a manifest error in the use of terms. Referring 
to the action of atmospheric pressure, the question is asked : 
"Is it the real factor, or simply an auxiliary?" No such lan- 
guage as this is known to mathematics or mechanics; every 
quantity, every force, power, condition, if you will, which 
assists in producing a given result, is a factor-a real factor, 
whether its numerical value be estimated at one or a million, 
1 See article (October No., p. 561) by Wm. H. Doughty, M.D., Augusta, Ga. 
2 Resume of a Report on Position, Pneumatic Pressure, and Mechanical Ap- 
pliance in Uterine Displacements. By Henry Fraser Campbell, M.D., Augus- 
ta, Ga. 1875. 4 
Campbell : Pneumatic Pressure in the 
unity or infinity ; and where several forces conjointly act to 
produce their common result, there is no one that can alone be 
called the real factor. 
The writer has given us what seems intended as a philo- 
sophical disquisition upon the process, speaks of factors, and 
employs a diagrammatic representation of forces. Hence, I 
shall hold him to the sphere of argument selected, and admit 
no hybrid terms. 
We shall see hereafter, by the language of the reviewer him- 
self, whether or not pneumatic pressure is a " real factor." 
After reading the review, one might be led to suppose that 
the author had been the first to call attention to the potent 
action of gravity, and that Dr. Campbell had not given full 
credit to its influence. Indeed, by some strange oversight in 
the opening paragraph, in quoting from the paper of Dr. 
Campbell, it is declared, " now it [the posture] is subordinated 
to the mere ' utilization of air-pressure as the instrumentality 
to effect uterine replacement.' " In the publication of Dr. 
Campbell, when speaking of the neglect into which this method 
had heretofore fallen, the sentence reads thus: " I am not 
aware of a single instance in which distinct mention is made of 
the genu-pectoral posture being applied for its true object, the 
utilization of airpressure as the instrumentality to effect 
uterine replacement, by gravity." The quotation in the review 
stopped short of the two little words, by gravity, although they 
were all that remained to complete the period; and gravity was 
to have so important a place in the discussion which was just 
being entered upon-was to be brought prominently forward, 
as par excellence the " potent factor" ! 
So important did Dr. Campbell regard the influence of 
gravity, that in giving a familiar, easy, and approximate illus- 
tration of the process by the reversed pneumatic syringe, he rep- 
resented gravity or the weight, in his diagram (Fig. 1), by a 
large volume attached to the handle; and to be more explicit, I 
introduce this and the other cuts from his pamphlet, the sub- 
ject of the review. 
Without comment, I give other quotations from Dr. Camp- 
bell, in which gravity is emphatically mentioned in various 
connections. 
In describing accurately the genu-pectoral posture, he gives Reduction of Uterine Luxations. 
5 
the accompanying outlines, indicating that of the true posture 
and two of the improper variations from it (Fig. 2). The first, 
he says, "represents the most complete reversal of the bearing 
of gravity that the human body can practicably be made to 
effect upon the same plane. The second figure scarcely re- 
quires particular description, as the manner in which the reversal 
of gravity must fail is sufficiently obvious. The last is to 
indicate an outline of the body which, though entirely different 
from the other, is still equally unfavorable to the reversal of 
gravity in a way that would promote uterine replacement by 
equilibrium of pressure." 1 Again, in regard to rectal inflation, 
Fig t.-Reversed pneumatic 
pump. 
Fig. 2.-Outline of the true pos- 
ture and variations from it. 
he says it may serve in certain cases to " dislodge the fundus 
from tlie hollow of the sacrum, thereby making restitution by 
vaginal inflation and inverted gravity easier and more certain." 
In referring to the rationale of the process of reduction, he says: 
" Inverted gravity is undoubtedly the force principally acting, 
but it is kept in the most powerless abeyance, until downward 
pressure, through the vulva, is supplied, k to restore the equi- 
librium,1 as the physicists would perhaps express the process." 
1 " She must not pitch forwards and make the pelvian angle obtuse, nor 
draw the knees up under the body, making it more acute," etc. Sims : Ute- 
rine Surgery, pp. 13, 14. 6 
Campbell : Pneumatic Pressure in the 
And in speaking of the terms in use, which might lead to 
errors in the use of the posture, he says : " ' Knee-elbow position,' 
' quadrupedal posture,' and especially the term ' all-fours,' are 
names which fail to describe, accurately, knee-and-breast pos- 
ture. They do not indicate a position of the body in which the 
gravity 1 of the organs becomes inverted." u 
So much for gravity. 
Although the author of the review has been " long familiar 
with the knee-chest posture," and though " early taught the 
requisites for its skilful performance," we might be led to sup- 
pose that this familiarity had given but little satisfaction in 
the past, and that the value of these early lessons had just now 
begun to be doubted; when on the next page he speaks so dis- 
paragingly of its superior advantages, in connection with his 
mention of the knee-elbow and other postures, which are very 
good, it is true, as far as they go. Indeed, the many failures 
which he informs us he has experienced in the attempt to 
replace retroversions after raising the perineum, may be due to 
this very fact, that he does not fully appreciate and avail 
himself of the greater power which may be evoked by the 
gcavepectoral posture. 
On the first page of the review it is stated, " we have so often 
reduced this class of displacements, with and without careful 
regard to the admission of air into the vagina," etc.; and, on 
the very next page, " we have so often in retroversions raised 
the perineum with two fingers, with a free admission of air into 
the vagina, without witnessing this magical replacement" 2 
etc. Such experience with pneumatic pressure in the genu- 
pectoral posture seems, by these several statements, to have 
been characterized by very abrupt and rapid oscillations, the 
barometric index-in this instance of applied aerostatics- 
changing in degree and kind with as little premonition as the 
variable mercury on an unsettled day. Furthermore, any one 
is certainly in error who for a moment supposes that the ad- 
vocates of this method of treatment regard it as characterized 
by " universal and uniform success; " if such were the case, it 
would differ from every other agent, instrumentality, or device 
known in medicine. 
Like nearly the entire article, the third paragraph of the 
1 The capitals are mine. 2 The italics are mine. Reduction of Uterine Luxations. 
7 
criticism contains within its own limits all that is needed for 
its complete refutation. " Reduction often made in this posi- 
tion," it is argued, " with total neglect of this special condition, 
is proof that it is not indispensable, unless1 it be held that it has 
been unconsciously used by operators who have failed to recog- 
nize its presence and merits." 
Now, what is the inference to be drawn from this? It evi- 
dently is, that if " it be held" by competent authority, that air- 
pressure " has been unconsciously used," the frequent reduc- 
tions thus made are no longer proof that air-pressure is not 
indispensable; but tend rather to prove that this factor is a 
sine qua non in the process. Our authority that air Ims been 
unwittingly used is conveniently furnished for us in the next 
sentence, when it is affirmed, " we believe it true . . . that 
the introduction of more or less air does take place-Indeed, 
could hardly be avoided?'1 Ergo, the very opposite has been 
substantiated to that which the writer started out to prove. 
Nor from the foregoing does it logically follow that " for 
that reason the immediate, spontaneous rectification of the 
uterus ought to have been so constantly1 observed." For such 
instantaneous and unfailing success is claimed neither for this 
method nor for any other human device; and " the notable in- 
stances now made public," though they may give rise to a 
proper admiration for this "beautiful" reduction in the mind 
of every sincere seeker of truth; and place upon a lasting basis 
the process by which it is accomplished ; yet toothers who have 
been " long familiar " with this " very ready method " of re- 
duction, these successes have themselves for some time been no 
longer "objects of wonder and puzzling contemplation." 
Passing over minor points, let us now take up what is evi- 
dently considered the climax of the argument-the point at 
which a cumulative effect has been produced-where the 
weight of logic, becoming more and more powerful, is just about 
to descend like an avalanche, carrying all resistance before it. 
" Observe that it is the posture," says the reviewer, " that has dis- 
turbed the equilibrium, the restoration of which demands the 
admission of air, not as the factor in the replacement, but for 
the one purpose of neutralizing the intra-abdominal pressure, 
and thereby leave the gravitation of the pelvic viscera to con- 
1 The italics are mine. 8 
Campbell': Pneumatic Pressure in the 
tend without restriction with the ordinary resistance to their 
return." Mark the language used-the admission of air is now 
demanded in order to restore the equilibrium, and leave the 
gravitation of the viscera to contend, etc.; and yet this condi- 
tion, this power, this force, which is so important as to be " de- 
manded," is not a factor in the replacement-that force which 
it is declared, has a "purpose" to perform; which must itself 
loosen ttye shackles of gravity, that it, " the potent factor," may 
act. 
The expression " the factor " is constantly used; the ele- 
mentary principle already alluded to, apparently not being 
understood, that where an effect is obtained, a result produced, 
by the consentaneous action of several causes, agencies, or 
Fig. 3-Retroversion in the genu-pectoral posture. 
forces, they are each termed factors, no matter what the com- 
parative power of each individual factor may be. 
"In invoking gravity for the relief of retroversions," con- 
tinues our author, "in the knee-chest or elbow posture, the 
entrance of air into the vagina, except in minor degrees of dis- 
placement, becomes necessary in order to relieve a necessity 
created by the posture itself." Alas for the meaning of 
language! An agency which is so indispensable, so potent, as 
to be demanded in the chain of events that brings about the 
end; which " becomes necessary in order to relieve a necessity; " 
we are requested to " observe "-lest we should logically ob- 
serve something very different-is not a factor in that result, 
for the accomplishment of which, it " becomes necessary to re- 
lieve a necessity " ! Reduction of Uterine Luxations. 
9 
x'he truth has become so potent as to struggle forth in the 
emphasis of this awkward tautology; although the reasoner him- 
self fails to see its force, to prove the error of his conclusion. 
" Created," it is added, " by the posture itself." No matter just 
now how the necessity is created, so far as the importance of 
the air-pressure is concerned to relieve the necessity. I am not 
the champion of any one particular factor, denying the potency 
of any of the others-for air-pressure versus gravity as evoked 
by the posture, or vice versa. The question is. by what means 
is this so-called necessity relieved, that the process may be com- 
pleted, and the uterus restored. This the reviewer himself tells 
us is accomplished by " the admission of air." 
" Seeing then its function is limited to this particular duty," 
continues our critic, " it cannot be considered the real factor." 
As it confessedly has a " function," a " particular duty," it is 
declared by implication in these very terms, that it is one of the 
factors; and (of course) a real factor, if the English language 
has any meaning. 
Further, " it becomes an antecedent to the forcible employ- 
ment of gravity alone in fortunate cases." If this means any- 
thing, it implies that in the varieties of uterine displacements 
easily reduced, air on its admission first exerts its influence ; 
which is then followed by, and renders possible, not only the 
employment of gravity, but its forcible employment; and that 
this is sufficient alone to accomplish the reduction. What 
greater tribute to the potency of pneumatic pressure could its 
most earnest advocates desire ! 
" And to gravity supplemented by direct manual or instru- 
mental means in those less so." Have the rules of loffic no 
longer any force? Are premises no longer the guides to con- 
clusions ? Shall a force so important that it is dignified with 
the distinction that it becomes an antecedent-acting first in 
the order of time-not only to gravity, but to its forcible em- 
ployment in cases easily reducible, and which in the more 
difficult, too, acts as an antecedent to gravity assisted by other 
means ; which is demanded to restore the equilibrium ; which 
thus neutralizes the intra-abdominal pressure, leaving the gravi- 
tation of the pelvic viscera to contend without restriction, etc., 
etc. ; shall all this, I say, be predicated as the function of a 
force, to dismiss it in the next breath with the contemptuous. 10 
Campbell : Pneumatic Pressure in the 
peculiar, and-in this connection-certainly original expression 
" it is at most an auxiliary" I 
Finally, it is triumphantly stated that " complete vaginal 
distention-that balloon-like inflation-becomes only possible, 
after or simultaneously with {not before) reduction, and is in 
no wise the cause of the replacement? I regret that the re- 
viewer has done his argument so much injustice as to forget that 
in many well-known processes causes and their effects are often 
simultaneous. It is not important for my argument at what 
exact moment of time complete distention is accomplished ; nor 
has this been the topic at issue. As the hackneyed fallacy of 
post hoc propter hoc has been significantly alluded to, I am 
here reminded with much greater propriety of the fallacy, no 
less familiar, termed ignoratio elenchi. What I am establish- 
ing is-and by the reviewer's own premises-that pneumatic 
pressure is an important factor in the reduction ; whether it 
begins to exert its power at the moment of time when it is first 
admitted, or at the moment when distention is completed, or 
whether it acts continuously in the interval between these 
limits. The fact is that in cases amenable to this method the 
process of reduction of the displacement and that of distention 
of the vagina proceed pari passu with each other-the air-pres- 
sure is acting all the time-and complete distention and com- 
plete reduction are at one and the same time accomplished.1 
Nor does all this at all effect the claims as to the potency of 
air-pressure per se as a factor in the reduction; nor does this 
infinitesimally short period of time that may intervene between 
the entrance of air and the complete distention of the vagina 
make any difference ; for the reviewer himself tells us that in 
favorable cases " the uterus rectifies itself almost instantly upon 
the admission of air." 
In admitting that " the pneumatic pump affords a very good 
illustration of the mechanism here given," a very good illustra- 
1 ' ' Thus we obtain, in this case, a solution of the difficulty which is placed 
before us. The instantaneous effect or change is simultaneous with the in- 
stantaneous force or cause by which it is produced. . . There is a progres- 
sive cause and a progressive effect which go on together and occupy the same 
finite time; and this simultaneous progression is composed of all the simul- 
taneous instantaneous steps of cause and effect. The aggregate cause is the 
sum of the progression of causes; the final effect is the last term of the 
progression of effects."-Whewell: History of Scientific Ideas. Reduction of Uterine Luxations. 
11 
tion is also afforded us of the fallacy of the argument above 
quoted. For to offer as an argument that this alien, " complete 
vaginal distention " . . . " becomes only possible after or simul- 
taneously with, not before, reduction, and is in no wise the 
cause of the replacement," in order to prove that the air-pressure 
per se is not a powerful factor, is as illogical and meaningless 
Fig. 4.-Reduction by pneumatic pressure and the genu-pectoral posture 
as to say that the atmospheric pressure does not act as a factor 
-an important factor, the determining factor-in causing the 
descent of the piston of the reversed pneumatic pump (Fig. 1), 
because the barrel of the pump above it does not become com- 
pletely filled with air until after or at the instant that the pis- 
ton has descended '. The statement, though absurd, would be 
exactly parallel and of equal force. 
I have thus briefly shown that a force-which is " demanded " 
in a process; which has "a purpose " to accomplish ; which 
" neutralizes " an opposing force ; which " becomes necessary to 
Fig. 5.-Campbell's pneumatic repositor. 
relieve a necessity"; which has a "function," a "particular 
duty " to perforin; which " becomes an antecedent " to the forci- 
ble action of "the potent factor"; which " equilibrates " other 
contending forces; upon whose action, in appropriate cases, the 12 
Campbell : Pneumatic Pressure in the 
result is " almost instantly " accomplished-through whatever 
medium or instrumentality it is supplied, can be-by the simple 
significance of language and at the tribunal of common sense- 
no other than a most important and indispensable factor. 
Consequently, " these views " of the interrogator, if he thereby 
means his conclusions, cannot be maintained as logical sequences 
to his own premises; and the glass air-way-the simple device 
for self-treatment, under certain conditions, throifgh which this 
factor may be conveniently employed-is in every " proper 
sense," and to al] intents and purposes, a uterine repositor. 
As to the question of self-replacement, it is scarcely neces- 
sary to state that its objects' have apparently been misunderstood 
by the writer of the adverse review. As to the validity of its 
claims as a method to be employed under the circumstances for 
which it is recommended, this follows as a direct and necessary 
corollary upon the already well-established claims of pneu- 
matic pressure and the yenu-pectoral posture. 
In his valuable and comprehensive "Report3 on the Progress 
of Gynecology during the year 1875," Dr. Paul F. Munde gives 
as one of the four advances "the growing appreciation of the 
influence of posture on the health of the female sex, and the 
recognition of the value of posture, especially if aided by pneu- 
matic pressure, in the treatment of uterine displacements." 
In his paper on the "Reposition of Retro-displacement of the 
Gravid Uterus by Posture and Atmospheric Pressure," Dr. 
Mundd says, " these doubts as to the power of air-pressure in the 
vagina certainly confirm the impression I had gathered touch- 
ing the ignorance or want of appreciation of the profession of 
this simple, but nevertheless powerful instrumentality ; " and 
again, "I do not hesitate to express my unqualified support of 
the principles of treatment advocated by Dr. Campbell; and 
my belief that its universal appreciation and adoption will be of 
great benefit to the suffering female sex." 3 
In the discussion of Dr. Campbell's paper, presented to the 
1 See Abstract of Proceedings of American Gynecological Society, Am. 
Jour. Obstetrics, Oct., 1876, pp. 584-5; and for Prof. H. F. Campbell's views 
at length on this subject, see Volume of the Society's Transactions at the 
First Annual Meeting in New York, in September, 1876. 
4 Am. Jour. Obstetrics, April, 1876, p. 173. 
3 Am. Jour. Obstetrics, June, 1876, pp. 297, 300. Reduction of Uterine Luxations. 
13 
American Gynecological Society at its late meeting in Septem- 
ber, "Dr. Emmet spoke favorably of the method, and regarded 
the glass tube as an important acquisition in carrying it out.*'1 
The endorsement of pneumatic pressure and the genu-pecto- 
ral posture, in their varied applications, by other prominent 
writers and practitioners2 in America, England, and Germany, 
renders it scarcely necessary, in a brief paper like the present, 
to notice in detail the several petty exceptions taken in the 
review. Though my special object was to consider the open 
question propounded, I hastily add the following concluding 
rejoinders: - 
1. That even after the most skilful reduction and the adjust- 
ment of a proper support, self-replacement is often by no means 
" a superfluity; " for the uterus will frequently settle down 
upon or in spite of the pessary, or return in some degree to its 
former obliquity. Self-replacement in many instances will 
correct this condition, supplementing the action of the instru- 
ment and enabling it to be borne. 
2. That though the patulous condition of the vaginal strait 
will in some cases cause the entrance of air on the assumption 
of the posture alone, this does not impair the principle upon 
which the use of the pneumatic repositor is based ; and in 
many cases of a different conformation, it will prove a valuable 
convenience to insuie a free and certain ingress of air. 
3. That while the advocates of this method would by no means 
banish other valuable positions and methods of replacement, 
the genu-pectoral posture when employed in diagnosis does not 
" deny " such " useful knowledge " as the degree of contrac- 
tility of the vagina and its relations with the uterus. On the 
contrary, it sometimes has this advantage: the examining 
finger introduced and excluding the air, until the os, vaginal 
walls, and cul-de-sac have been sufficiently explored, may then 
1 Am Jour. Obst., Oct., 1876, p. 684. 
2 See Abstract of Proceedings British Med. Association : Influence of Pos- 
ture in the Treatment of Uterine Disorders, by Arthur W. Edis, M.D., Obst. 
Jour. Gr. B. & I., Oct., 1876, p. 463. Dr. Solger, Berlin: Beitrdge zur Ge- 
burtshulfe und Gynakologie, Vol. IV., No. 1, quoted by Dr. Munde (loc. cit.). 
See views of Dr. Robert Battey, Atlanta Med. & Surg. Journal, June, 1875, pp, 
135-6; ibid., July, 1875, p. 231; Dr. T. S. Hopkins, ibid., Nov., 1875, pp. 449- 
452. Transactions Medical Association of Georgia, Dr. W. O'Daniel's Report, 
p. 61. Dr. James D. Trask, Medical Record, May 6, 1876; and Obst. Jour. 
Gr. Br. and Ir., May, 1876, Am. Sup., p. 22. 14 
Campbell : Pneumatic Pressure, etc. 
elevate the perineum, following the receding uterus after the 
admission of air, and thus derive additional knowledge as to 
" the extent and direction of motion possible to the dislocated 
organ." 
4. That in "fitting " the pessary, after such information has 
been obtained, it is not to be supposed that the intelligent gyne- 
cologist will be led astray merely by the subsequent distention 
of the vagina; for he already knows that no matter how great 
the expansibility may be, it is especially desirable, in all cases, 
that the lateral walls should be distended as little as possible by 
the support; so that it may enable the vagina to regain, and 
not still further decrease, its already diminished tonicity. 
5. That it has well been added, in regard to the introduc- 
tion of pessaries, that " after the reduction of the displace- 
ment " they may be as painlessly introduced on the back. But 
in no other than one of the knee postures (and best, of course, 
the knee-6rms'Z), can the previous reduction be made so easily, 
fully, and painlessly. Bimanual palpation is undoubtedly to be 
made, when necessary, in its appropriate position ; and before 
the introduction of the support. Complete reduction may then 
be made in the knee-breast posture, a change to which is the 
part of wisdom, not " folly," if a more perfect restoration of 
the uterus and superincumbent viscera to their normal rela- 
tions can thereby be obtained, or the patient saved the least 
degree, of pain consequent upon the direct application of 
manual force in a less potential and subsidiary posture. 
6. That the three important factors that may be evoked in 
the genu-pectoral posture as applied in the reduction of uterine 
displacements, are: First, the force of gravity; second, the 
force of pneumatic pressure ; and third, the force of the intra- 
abdominal detraction, variously termed " suction," " draught 
of the viscera " (Campbell), " suction or traction away from 
the pelvic organs," " vis a fronte " (Munde), " negative intra- 
abdominal pressure " (Solger). 
7. That self-replacement, when properly understood and 
employed, is an admirable conception and a most valuable 
resource.