[Extract from the May number of the Atlanta Medical and Surgical Journal. ] 
RESUME OF A REPORT 
ON 
POSITION, PNEUMATIC PRESSURE 
AND MECHANICAL APPLIANCE 
IN 
Uterine Displacements 
Read before the Georgia Medical Association at Savanna# April 23 d, 1875. 
By HENRY FRASER CAMPBELL, A.M., M.D. 
Chairman of the Committee on Gynaecology for the Eighth District 
of Georgia; Sanitary Commissioner fob the Eighth District of 
Georgia; Late President of the Georgia Medical Associ- 
ation ; Formerly Vice-President of the American 
Medical Association; Formerly Consulting 
Surgeon to Georgia Military Hospital 
at Richmond; Formerly Professor 
of Surgery in the New Orleans School of Medicine; Member of the 
Biological Department of the Academy of Natural Sciences of 
Philadelphia; Corresponding Member of the Imperial 
Academy of St. Petersburg, Russia; and Profes- 
sor of Operative Surgery and Gynaecology 
in the Medical Department of the 
University of Georgia. 
"Truth's deathless voice pauses among mankind."-Edinburgh Review. 
ATLANTA, GEORGIA: 
DUNLOP & DICKSON, PRINTERS, 11 NORTH BROAD STREET, 
1875. RESUM E. 
The accompanying synopsis having been submitted to my 
revision, both in the manuscript and the proof, I must content 
myself with allowing it to go to distribution, as my own paper. 
Inasmuch, however, as this Journal may reach many who may 
never see the fuller discussion, to be published in the Transac- 
tions of the Georgia Medical Association, a few words of explan- 
ation may not be deemed' altogether unimportant; for while it 
contains nearly all the essentials of the Report it is intended to 
condense, the restricted and compendious scope of such a resume 
allows room for little more than " bare assertion." 
I have refrained for years, from any published discussion of 
this important measure of treatment, while I have, during that 
time, fully demonstrated its principles and pointed out its appli- 
cations, in my clinical lectures to medical classes. It has appeared 
to me that, unless its announcement were incorporated with some 
extended exposition of its value, in connection with the various 
forms of uterine displacement and the conditions to which it is 
applicable, its fate would be that of many most valuable ideas, 
which, though of admitted merit, had, from inadequate presenta- 
tion, failed either to fix the attention or to modify the procedures 
of the profession. Indeed, knee-and-breast posture, as a measure 
of uterine reposition, presents a curious illustration of such a 
tendency. It seems to have been signally fated to pass from the 
minds and out of the practice of some of the most distinguished 
men who have had the opportunity of utilizing it to this impor- 
tant end. In regard to the note referring to Dr. Sims in the 
resume, we can only say, that his connection with the revival of 
knee-and-breast posture has been fully and, we hope, most fairly 
-considered in our report. Every one must admit that it was only 
the transcendant brilliancy of his achievements, in the department 4 
UTERINE DISPLACEMENTS 
of operative gnyaecology, which could have diverted him from 
placing a more enduring value upon such an experience, even 
though it was but indirectly related to the objects of his, then, 
pursuit. I cannot find that he has advised the measure anywhere, 
as a systematic method of treatment for uterine malposition, and 
it is plain that neither from his writings, dating since 1852 to the 
present time, nor from the writings of any others, has it yet 
become one of the established precepts of the books. 
As just intimated, this valuable method has probably failed of 
general adoption for want of adequate presentation, as a means 
distinctly proposed and insisted on, for the correction of malpositions. 
No one, perhaps, could more clearly understand and describe the 
position and its results than did Dr. Sims in the advice given by 
him for the use of his speculum in certain surgical operations 
upon the womb. The following directions are condensed from 
his works, which I present in connection with one or two of the 
illustrations from my own Report in the forthcoming Transac- 
tions. Like the others, they are from original drawings, by my 
nephew and colleague, Dr. A. Sibley Campbell, of Augusta. The 
figure is divested of clothing, that the relaxed abdominal muscles 
and curved spine may be presented in proper outline. 
Fig. 1. 
THE GENU-PECTOKAL POSITP 
Let the patient loosen all strings and fastenings of the dress 
and corsets, and place herself on the bed on her knees, bending 
the body forward, till the head and thorax are brought down to 
the same plane as that on which the knees are resting, viz: the 
surface of the bed. The face may be turned to one side, resting 
in the two hands, while the elbows are thrown out widely from  
5 
the sides. The knees are to be separated from five to ten inches. 
The thighs must be perpendicular to the surface of the bed. " She 
must not arch the spine upwards, for this brings into forcible 
action the abdominal muscles, which should be perfectly relaxed, 
with the spine curved downwards as we see it in sway-backed 
animals. With these precautions fully impressed upon her, she 
is to breathe easily and relax the muscles of the abdomen." 
There are one or two errors to which patients are liable in 
taking their position. They also are described by Dr. Sims. They 
were deemed of sufficient importance to be contrasted in our 
Report with the diagram-outline representing the true posture. 
Fig. 2. 
The first represents the outline having all portions of the 
body in propel' relation with the plane surface upon which the 
figure rests. The perpendicular line, representing the thigh, 
elevates the hips to the highest attainable point, while the down- 
ward curve, towards the resting point, the breast, indicates the 
sudden and rapid decline from that elevation. This represents 
the most complete reversal of the bearing ,of gravity that the hu- 
man body can practicably be made to effect upon the same plane. 
The second figure scarcely requires particular description, as 
the manner in which the reversal of gravity must fail is suffi- 
ciently obvious. 
The last is to indicate an outline of the body which, though 
• entirely different from the other, is still equally unfavorable to 6 
UTERINE DISPLACEMENTS. 
the reversal of gravity in a way that would promote uterine re- 
placement, by equilibrium of pressure. 
The position having been taken as indicated by the above 
directions and by the proper outlines, all that is necessary for 
self-replacement is the introduction of the repositor for a moment 
or two, as elsewhere indicated in these notes. 
That knee-and-breast posture, so familiar to many for some 
time past, for certain purposes of surgery, should be made the 
subject of an extended report, will doubtless be a matter of some 
surprise to many. But it will perhaps occasion astonishment no 
less decided, should they, on searching the standard works on 
gynaecology, published during the past thirty years, both in this 
and foreign countries, find that even the posture is scarcely more 
than alluded to as a means of reducing the womb in any of its 
dislocations. The one or two exceptions to this, will be found in 
the works of Dr. T. Gaillard Thomas, of New York, and of Dr. 
Robert Barnes, of London. There may be others, but if such 
there be, diligent search has failed to make me familiar with them, 
up to this time. In these works it is the posture alone that is 
suggested-pneumatic pressure, the indispensable condition of 
power and the real instrumentality and sine qua non in the pro- 
cess of replacement advocated in my Report, is not once, even 
alluded to. The journal literature of this and other countries, 
for some years past, has teemed with discussions upon " postural 
treatment," for various abnormal conditions of both men and 
women. I do not recall, but a very few, in which uterine reposi- 
tion at all, is their object; and 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 air-pressure as 
the instrumentality to effect uterine replacement, by gravity. If 
there is any such indoctrination, either in the books or the jour- 
nals of the last twenty years, besides those above referred to, it 
is more my misfortune than my fault that I have not become 
familiar with them* And though the chapter of my Report re- 
lating to the history of knee-and-breast posture is closed, full 
* For some time past, Dr. J. H. Aveling has been furnishing to the pages 
of the Obstetrical Journal of Great Britain and Ireland, valuable discussions on 
" The Influence of Posture on Women." He speaks several times, of " knee- 
elbow " posture as being found advantageous, but I do not find that he any- 
where mentions air-pressure, or the introduction of air into the vagina, as an 
important element in carrying out any process for which he recommends the 
position. UTERINE DISPLACEMENTS. 
7 
credit will be gladly given to the authors, for their praiseworthy, 
even though unsuccessful, efforts to fix attention upon this most 
valuable method of correcting the malpositions of the uterus.* 
It will be recollected that the use made of the measure by 
Drs. Sims and Bozeman had in view a far different object-not 
uterine reposition at all-but operations within the vagina for 
the cure of vesico-vaginal fistula and other accidents and affec- 
tions, of a purely surgical nature. In the Report just pronounced 
by me at Savannah, the. object was distinctly proclaimed. It was to 
establish among gynaecologists generally, in this as well as in foreign 
countries, pneumatic pressure, as it can be evoked and utilized in the 
genu-pectoral position, as a constantly available and poiverful instru- 
mentality; not only for occasional use, in unusual and difficult cases 
of displacement, but for daily application also, in the mildest forms 
and degrees of uterine malposition. The use and benefits of this 
method would be greatly restricted and depreciated should its ap- 
plication involve the attention, each time, of the physician or even 
a nurse; it became therefore an object of earnest thought, that I 
might place in the hands of suffering womeu, through their medi- 
cal advisers, an ever safe and "ready method" of self-replacement, 
by which, in most cases, instantaneous relief maybe secured from, 
not only the distress and many inexplicable discomforts of uterine 
dislocation, but, far more important, from the imminent dangers, 
to both mother and offspring, which, from this cause alone, con- 
stantly hang around and imperil the yearned-for result, in the 
earlier months of gestation. I cannot but believe that to uterine 
displacements, more than to any other cause-more than to all 
other causes combined-is due the alarming frequency of abor- 
tions, in the period before, and about the time of, quickening. 
Frequent replacement lessens these dangers, facilitates quicken- 
ing, or at least, ascent of the womb, and anticipates the liability 
to impaction. 
Nightly self-replacement greatly mitigates-indeed, often en- 
tirely relieves, the irritations, whether local or reflected, which 
are known to arise from varying degrees and forms of displace- 
ment, which, as is argued in the Report, are not only incident to, 
but are almost normal attendants upon, the earlier months of preg- 
* From my eminent and most erudite friend, Dr. John T. Metcalfe, of 
New York, I have received some rare and very important records, relating to 
the History of Knee-and Breast Posture. For this highly valued kindness, I 
here render my grateful ledgments to that distinguished gentleman. 8 
UTERINE DISPLACEMENTS. 
nancy. Every one is familiar with the distress arising from these 
gravid displacements. Locally, they are vesical and rectal irrita- 
tion, tenesmus, sense of weight and downward pressure-" falling 
out"-vaginal and vulvar irritation-leucorrhoea, sometimes with 
dangerous contraction; frequent uterine and abdominal pains, 
with threatenings of abortion. Among the reflex irritations of 
early pregnancy, which are exaggerated by "gravid displace- 
ment," perhaps nausea or " morning sickness " is the most prom- 
inent and distressing; for it will be understood that lying down 
all night will not benefit a prolapsus unless replacement has been 
made on going to bed. Hysterical nervousness, wakefulness, and 
many of the nondescript miseries of these early months are also, 
as every one knows, but manifestations of reflected uterine irri- 
tation. 
Like others,* I have sometimes found the continued support 
afforded by a well-adjusted pessary, until after the period of 
quickening, to act well in lessening the above troubles. Many 
patients, however, are averse to them while in the pregnant con- 
dition, and cannot be induced to submit to their introduction at 
that time. When nightly self-replacement, by means of the pneu- 
matic repositor, shall become fully recognized by the profession 
and uniformly commended by us to pregnant women, under the 
above circumstances, I faithfully and most hopefully believe that 
many of them who now suffer and drag out these months in 
dread and apprehension, will be assisted-will assist themselves- 
to pass this distressing stage in comparative quiet and comfort, 
and that many a foetus, now doomed to perish under its neglect, 
will be carried prosperously on to safe delivery. 
Rectal Inflation.-I have known, for a long time, that the 
rectum, no less than the vagina, could be made, in the genu-pec- 
toral posture, the subject of wide distension by air-pressure per 
anum. In a case of reputed stricture of this canal, which, on 
examination with my distinguished friend, Dr. Joseph A. Eve, of 
this city,f we found to be one of retroversion of the uterus, I 
* Clinical Observations on the use of Pessaries in the early months of 
Pregnancy. By Albert H. Smith, 31. D., etc. {See American supplement to 
Obstetrical Journal of Great Britain and Ireland' 
t As it has given me pleasure to mention Dr. Eve in connection with the 
above case, I must also present him fairly. Though, for years, he has used 
knee-and-breast posture as a means of uterine reduction, and taught it from 
his chair of obstetrics, he does not fully coincide in the rationale of the pro- 
cess as expressed in the phrase Pneumatic Pressure. We think the differ- UTERINE DISPLACEMENTS. 
9 
■carefully experimented and noted the effect of air-entrance, first 
into the rectum and then into the vagina, upon the position and 
direction of the displaced womb. 
The vagina was kept strictly closed until after an observation 
upon the rectum. The rectum was, to all intents and purposes, 
converted into a colpeurynter. The distension of its walls had 
the effect, in this case, of partially dislodging the fundus from 
the hollow of the sacrum-there was no impaction-as I suppose 
Braun's colpeuynter would do, if inflated within this cavity. The 
position of the displaced womb was considerably changed, but its 
direction, not at all. After carefully considering the condition of 
the cavity and the relation of the fundus uteri to the face of the 
sacrum, the obliquity was instantly corrected by the additional 
admission of air into the vagina. 
One of the uses which, I think, can be made hereafter of rec- 
tal distension as above described, is that it may offer a facility to 
reposition, in certain cases of retroversion; that it may serve, as 
in the above instance, where there is neither adhesion nor impac- 
tion, to dislodge the fundus from the holloiv of the sacrum, thereby 
making restitution by vaginal inflation and inverted gravity easier 
and more certain. Alone, it can never be made to effect the re- 
position of this backward obliquity. Indeed, we never had any 
very great reliance even on the principle claimed for the action 
of the India rubber bag to be inflated in the rectum, generally 
known as the colpeuyntwr. In actual practice, I have ever found 
it simply unendurable. 
Classification.-As to the Synoptical Arrangement, which I 
have allowed to be herein transferred from the Report, it is only 
hoped that the attempt will not be prejudged unfavorably. It 
must be evident to every careful reader of many of the journals 
and some of the standard monographs of the present day, that 
there is much looseness, so to speak, in the application of some 
of the terms which should differentiate uterine displacements. 
Many times, it is only with the greatest care and repeated study 
of the context, that we can determine, accurately, the true mean- 
ing of those who report and describe cases. How often do we 
find versions miscalled as flexions. Every one must perceive-in 
ence is scarcely a real one. Inverted gravity is undoubtedly the force prin- 
cipally acting, but it is kept in the most powerless abeyance, until downward 
pressure, through the vulva, is supplied, "to restore the equilibrium," as the 
Physicists would perhaps express the process. 10 
UTERINE DISPLACEMENTS. 
time at least, it will be perceived-that some pointed and clearly 
discriminating presentation of the now generally recognized 
differences in displacements, is urgently demanded, to check and 
to clear up the momentarily deepening confusion. The table 
here offered, inadequate as it may be, has cost much labor and 
no little anxious reflection. I cannot, however, argue it here. 
In the course of the foregoing remarks, introducing and ex- 
plaining the following synopsis, I earnestly hope there can be 
found not one presuming sentence or aggressive line. It will be 
admitted that the principles of treatment advocated in our Report 
have suffered for years, by one cause or another, the most unmer- 
ited neglect; till, at the present day, they have almost disappeared 
from among the teachings of gynaecology. Confusing names,* 
imperfect descriptions and hesitating recommendations have 
weakened the confidence in, and destroyed the value of, this ines- 
timable measure of treatment. In seeking to establish it now, 
I feel that I must not have laid at my door the charge of any 
half-way appeal for the attention and confidence of the profes- 
sion. Much would I prefer to lay myself liable to the charge of 
exaggerating its importance-if that were possible. It would 
seem something more than poetic inspiration that tells us: 
"Truth's deathless voice pauses among mankind." 
This voice, as will be shown hereafter, has, in this case, paused 
many times, in long, injurious silences-silences injurious to hu- 
manity. Is this most useful expedient again to disappear from 
among the precepts of the books and from the practice of medi- 
cal men ? Who can tell ? but most earnestly may we hope that 
it will not. In the present age, more than in any era of the past, 
there are potent influences which can rescue it from oblivion. 
When the power of inverted gravity, as can only be secured in 
this posture and by pneumatic pressure, comes to be generally 
understood, as a means of uterine replacement; when it is taught 
as such, in all the medical colleges; demonstrated in the hospitals; 
discussed fully and fairly in the societies and journals; distinctly 
and prominently insisted upon, as it is not anywhere now, in the 
standard works and text-books on gynaecology; when it shall be 
the ride, as most surely it will, that no pessary or other appliance of 
*" Knee-elbow position," "Quadrupedal posture," and especially the 
term "All-fours," are names which fail to describe, accurately, knee-and- 
breast posture. They do not indicate a position of the body in which the 
gravity of the organs becomes inverted. UTERINE DISPLACEMENTS. 
11 
iziZernaZ support shall be used without previous reduction of the dis- 
located uterus, by pneumatic pressure in the knee-and-breast posture: 
Again, when no less by the unhappy patients themselves, than 
by their medical attendants, self-replacement shall be recognized 
as " The Ready Method " of securing relief-relief from lumbar 
and sciatic pains, from aching knees, from vesical and rectal 
irritation; when it shall be known as a resource, often, for avert- 
ing abortion, and for educing magic comfort, out of the very 
midst of the Protean distresses of malposition; when, indeed, 
from their uniform relief to the suffering and the imperiled, pos- 
turing shall become as familiar as kneeling, and the repositor, as 
any implement of toilet convenience; then can we feel satisfied 
that this potent instrumentality has attained to the full and com- 
prehensive measure of its surpassing usefulness, and that it can 
never again fall into neglect and desuetude. 
Henry F. Campbell. 
Augusta, Georgia, April '2-Lth, 1875. 
SYNOPSIS. 
[I'rojn the Atlanta Medical and Surgical Journal, June, 1875.] 
TREATMENT OF UTERINE DISPLACEMENTS. 
Pbof. H. F. CAMPBELL, M.D., of Augusta, Ga. 
By the courtesy of a friend attending the Medical Association 
of Georgia, we are enabled to give the following abstract of Prof. 
Campbell's remarks at the recent meeting in Savannah, of which 
we gave a brief synopsis in our report in the May Journal. This 
paper was crowded out of that number.-Ed. Jour. 
Dr. Henry F. Campbell, of Augusta, Professor of Operative 
Surgery and Gynaecology in the Medical College of Georgia, was 
chairman of the Committee on Gynaecology for the Eighth Dis- 
trict. He gave a verbal resume of his lengthy report on Uterine 
Displacements and their Treatment by Position, Pneumatic Pres- 
sure and Mechanical Appliance. 
Dr. Campbell said : Every sexual abnormality may present 
two momentous desiderata: first, the health of the patient; sec- 12 
UTEBINE DISPLACEMENTS. 
ondly, the relief of sterility. Both these ends, it is well known, 
are materially compromised by uterine displacements. Scarcely 
any uterine affection can escape complication with some form or 
degree of malposition; and, on the other hand, no malposition 
can persistently continue without at least a liability to both struc- 
tural and functional change. He said that though the several 
affections, comprehended under the general head of uterine dis- 
placements, were well understood by the profession, and though 
they were generally carefully catalogued or tabulated in all works 
on diseases of women, still there is liability to misunderstanding 
and confusion in their study, on account of the imperfect and 
incomplete classification of the several species of malposition. 
The several forms of the various conditions recognized as " dis- 
placements," while they bear sufficient resemblance to each other 
to admit of class-association, still there are generic differences, 
which widely separate them, and which, until they are recognized 
in the tabulated classifications of the journals and books, must 
ever lead, and have already led, to much confusion in their dis- 
cussion. He is aware that any change in the established and 
long recognized relations of things, even though those relations 
may be false and inaccurate, is always regarded with disfavor by 
the profession; but inasmuch as, in this case, the evils of false 
classification must be felt by every one, and must constantly lead 
to increasing confusion year after year, he has proposed the fol- 
lowing arrangement, the principal feature of which may be said to 
consist in the introduction of genera and the recognition of generic 
differences, by which the vicious and incongruous association of 
incognate species has been substituted by one which is more 
congenial and natural. While the nomenclature of uterine dis- 
placements is, in general, sufficiently descriptive, new names, in 
many instances, might be substituted to advantage; still Dr. C. 
retains the long recognized terms, rather than incur the risk of 
confusion, which the introduction of new, even though more defi- 
nite ones, might produce. 
SYNOPTICAL ARRANGEMENT OF UTERINE DISPLACEMENTS. 
Definition.-Conditions of the uterus, more or less affecting 
the health and fecundity of the subject, in which, whether from 
elevation or depression; or from changed direction; or from altered 
form, this organ, or any portion of it, has become abnormally 
related, to either the planes or the axes of its containing cavity, 
the pelvis, or to the other organs therein contained. They may 
be recognized under the following several genera: UTERINE DISPLACEMENTS. 
13 
GENUS 1ST-MALPOSITIONS-ABERRATIONS OF LEVEL, OR NORMAL PLANE. 
fl. Ascent. 
b. Descent. 
c. Prolapsus. 
d. Procidentia. 
Influence on Menstruation, Conception and Pregnancy. 
1 Menstruation modified- generally excessive, without 
I pain. Prospects of conception-not always, but 
| generally, impaired. Pregnancy insecure-liable to 
J abortion until after quickening. 
GENUS 2d. OBLIQUITIES OR DEVIATIONS.-ABERRATIONS OF DIRECTION, OR OF 
NORMAL AXIS. 
Influence on Menstruation, Conception and Pregnancy. 
(Menstruation disturbed-generally painful. 
Prospects of conception always seriously impaired. 
Abortion always imminent at time of quickening. 
a. Anteversion. 
b. Retroversion. 
c. Latero-version. 
genus 3d. distortions-aberrations of form. 
Influence on Menstruation, Conception and 
Pregnan cy. 
1 In most of the species, menstruation is defi- 
cient and painful- "obstructive dysmenor- 
rhcea"-conception almost hopeless, from 
non-contact of "germ-cells with sperm- 
cells." In rare cases of accidental concep- 
tion, (as may happen to some of the spe- 
| cies) abortion, in most of them, almost in- 
evitable. Where the conditions of the 
sub-genus exist to the full degree, concep- 
J tion is impossible. 
a. Anteflexion. 
b. Retroflexion. 
c. Lateroflexion. 
d. Inversion. 
SUB-GENUS. * 
e. Cervical Elongation. 
f. Cervical Constriction. 
g. Tubal Constriction. 
As the title of the paper would indicate, position and what 
he styles "pneumatic pressure," has the fullest consideration in 
Dr. Campbell's report. He urges the importance and indispen- 
*These are associated as a "sub-genus"-for, though generally described 
with displacements, they are only distortions, but not displacements. We 
might, to the genera and species here arranged, have added what might be 
called "varieties"-thus: In every species of displacement there are degrees; 
there are all degrees of downward displacement-the division into species is 
sufficient for them-but in the "Obliquities," these degrees of fundal depres- 
sion might be graded into varieties; as also in the lateral deviations. Still 
more pertinent would be a series of varieties in the "Distortions," all degrees 
and directions of curve or angular bend; also the localities of the curve or 
bend; whether in the neck or in the body, (as some claim may occur) or at 
the junction of neck and body. Then again, in the sub-genus of distortions, 
we might also establish varieties; as the kinds and degrees of cervical elonga- 
tion; the kind and degrees of cervical constriction; whether congenital or 
acquired, whether plastic or inflammatory, complete or incomplete, straight 
or devious, etc. Again, in " tubal constriction," whether single or double, 
inflammatory or congestive or indurated, etc. All these abnormalities might 
be introduced, to constitute varieties, in legitimate accordance with the true 
principles of classification, but our earnest desire is to be useful, and such 
additions might complicate the tableau to such an extent that it might not 
be entertained and adopted by the profession. - Note added by Reporter in re- 
viewing proof sheets of Resume.-Editor. 14 
UTERINE DISPLACEMENTS. 
sable necessity of knee and breast posture, in the treatment of 
nearly all those conditions which can properly be called uterine 
displacements. He reports, in full, his satisfactory experience in 
the use of this "postural treatment" of uterine displacements, 
during a period of over thirty years. " It has been an unwritten 
tradition among many of the physicians of our school for years 
before my own time." In tracing the history of knee-and-breast 
posture, he finds that it is, by no means, a new or recent device- 
finding mention of it as applied, for one object or another, since 
the year 1701. Like many of the inventions of gymecology-as 
the speculum, the sponge-tent and uterine sound-"genu-pecto- 
ral posture" has been the subject, time after time, of discovery, 
oblivion, re-discovery, neglect and revival. The most recent re- 
vival of its application was that of Dr. Marion Sims, in 1852. 
His recommendations of it, for a brief period, called general at- 
tention to it, for only a particular class of operations-vesico- 
vaginal fistula, etc., but never secured its application by the pro- 
fession as an instrumentality in replacements of any form of 
uterine malposition. Dr. Sims, though he understood apparently 
its capabilities, did not appear to value it properly as a means of 
replacing the dislocated uterus. As in retroversion, the displace- 
ment for which, above all others, it is most valuable, he places 
the patient in "semi-prone position," abandoning gravity and 
pneumatic pressure, and using sponge probangs and a compli- 
cated process to imperfectly restore the displaced organ. 
Dr. Campbell adduced the writings of the late Dr. Milton 
Antony, of Augusta, as the most important revival of knee-and- 
breast position in recent times; also as the revival which, had it 
been generally published and known, would have extended its ap- 
plications to a wider range of cases and to the relief of a far more 
frequent and common class of distresses than any of the appli- 
cations it has found in its more recent inauguration by Dr. Sims. 
Dr. Antony's recommendation of the manceuvre was made in a 
series of papers published in the years 1836 and 1837; and it 
was for uterine displacements and examinations especially that 
he recommended it. Versions and flexions of the unimpregnated 
uterus were not, at that time, generally known; so that it was to 
the downward displacements alone that Milton Antony applied 
the method. Dr. Campbell claims that, since his earliest days of 
practice, he has used this postural treatment, applying it to every 
displacement possible, as its value became understood by him. UTERINE DISPLACEMENTS. 
15 
Using it as a means of diagnosis as well as of treatment, lie in- 
sists that no investigation of any form of uterine displacement 
can be thorough or conclusive without "'genu-pectoral " posture 
and "pneumatic pressure," by which we judge regarding the 
mobility, the extent of motion and the direction of motion pos- 
sible to the displaced organ. He insists that no pessary should 
ever be applied, or its application attempted, until after the dislo- 
cated organ has been reduced by knee-and-breast posture, assisted by 
pneumatic pressure. The ordinary introduction of the pessary 
often involves a painful pushing up of the prolapsed or retro- 
verted womb upon the pessary; whereas the womb should first be 
replacedfio its fullest extent, in knee-and-breast posture, and then 
the pessary laid upon the posterior vaginal cul-de-sac, while the 
woman is in the inverted position. As the patient rises to the 
erect kneeling posture, the womb settles down upon the posterior 
bar, or segment of the pessary, and thus she begins its use with 
comfort and freedom from pain. The particular rules, given by 
Dr. Hodge, for the application of his open lever pessary are dia- 
metrically reversed by Dr. Campbell, so as to adapt them to his 
far superior application of this valuable instrument in the "genu- 
pectoral position," after full reduction by "pneumatic pressure." 
"•j Self-Replacement.-That which may be regarded as perhaps 
the most triumphant achievement in the use of this most power- 
ful instrumentality for uterine reposition is what Dr. Campbell 
himself has termed "Self-replacement." 
Fig. 3. 
Breaking the Suction. 16 
UTERINE DISPLACEMENTS. 
In his discussion of the rationale of the "genu-pectoral posi- 
tion," he demonstrated clearly to all present that like a pneu- 
matic pump (which he actually used in the demonstration,) the 
descended womb, resting against the closed vulva, would not 
return to its position, even when dragged upon by its own weight, 
together with all the weight of the abdominal viscera, unless, as 
he expressed it, "the suction is broken" by the separation of the 
labia, to introduce air into the vagina, any more than was the 
piston of the reversed pneumatic syringe dragged down by the 
heavy book attached to the handle, until the thumb was removed 
from the opening above the plunger. He holds that in reduction 
of retroversions, except, in cases of adhesion or impaction, noth- 
ing is necessary but "genu-pectoral pneumatic pressure" and further, 
that Simpson's repositor, Bond's repositor, Sims' probangs, and 
the colpeurynter are useless instruments, except in extraordinary 
cases. 
Dr. Campbell stated that for years he had found difficulty in 
securing to patients the full advantages of knee-and-breast pos- 
ture from the fact that the womb would not replace itself, unless 
air was allowed to enter the vagina. His advice of "nightly replace- 
ment," only practicable by the patient herself, but in his mind a 
very great desideratum, constantly failed to afford relief on this 
account; also in the case of patients in the condition of virginity, 
often the subjects of displacements, but averse to any manipu- 
lative treatment, simple "genu-pectoral" posture would not re- 
lieve. He therefore, after many progressive attempts, perfected 
a simple instrument for the purpose of "pneumatic reduction of 
the dislocated uterus." 
Dr. Sims' duck-bill speculum, as used by Dr. Sims in his 
operations within the vagina, supplied him with an efficient and 
suggestive model for devising a method of establishing an "air- 
way " for " breaking the suction." This instrument, of course, was 
too expensive to supply one each to perhaps dozens of patients to 
whom he would wish advantageously to recommend "nightly self- 
replacement." He devised at one time a curved staff of vulcanite, 
some eighteen inches in length, tunnelled by a bore from the end 
to the curve, directing the patient to assume the position, and to 
reach back and introduce the perforated curved end into the vagi- 
na, that the air might entei' through the tunnel. This was found, 
in the first place, still too expensive, and then inconvenient, on UTERINE DISPLACEMENTS. 
17 
account of the interference by clothing, as well as by its inherent 
awkwardness of application. 
Fig. 4. 
Campbell's Uterine, Repositor. 
His "Pneumatic Self-Repositor" is the idea of an "air-way" 
reduced to the last degree of economy, simplicity and conve- 
nience. They are so cheap that they can be ordered from the 
manufacturer by the gross at a price little above the cost of 
ounce vials, and given if desired without charge to each pa- 
tient. It consists essentially of a glass tube of various forms, 
from two and one-half to three inches long, slightly curved near 
the end and bulbous, to admit of easy introduction. He pre- 
sented specimens of various forms and sizes of this instrument. 
Some, very attenuated in calibre, to use in virgins, to pass above 
the hymen, which is generally more or less lunated, without in- 
jury to that important membrane. The application is very sim- 
ple. The patient assumes the "genu-pectoral position," and, 
while thus placed, or before rising, with or without lubrication, 
she introduces the tube, only for a moment. The air rushes in, 
the suction is broken, and immediately, whatever may be the dis- 
placement, unless there is adhesion or impaction, " self-replace- 
ment" is completely and instantly accomplished. She then lies 
quietly down for the night, and a night's rest, with unstretched 
uterine ligaments, and unimpeded uterine circulation, if often and 
regularly repeated, will, at least, go far in favoring a restoration 
to a permanently normal positioh of the organ. 
The text of the report is illustrated by a number of original 
engravings, from the talented pencil of Dr. A. Sibley Campbell, of 
Augusta. These represent the several displacements of the 
uterus, and the process of their reduction by "position and pneu- 
matic pressure." 
Dr. C. also discusses the value of pessaries and other mechan- 
ical appliances, which he is far from discrediting. He also con- 
siders many of the attendant complications of uterine displace- 
ments and their various means of relief; but as "position and 18 
UTFRINE DISPLACEMENTS. 
pneumatic pressure" comprehended the chief peculiarities of his 
report, we await the appearance of the forthcoming volume of 
Transactions, rather than extend any further what was intended 
as only a compendious resume. 
Dr. Battey, of Atlanta, rose and said : The mention of the 
name of Milton Antony, in Dr. Campbell's report, stirs within 
me feelings of admiration, of gratitude and of deepest venera- 
tion. He was the friend and medical adviser of my father and 
of my sainted mother, who, with him, have long since gone to 
their rest, and hence mu friend. His kindly and succoring hand 
opened for the first time my eyes to the light of glorious day, 
and safely conducted me through the perils of puling infancy. 
He died while I was yet too young to know anything but his' 
kindness and almost God-like benevolence. That he was 'a man 
of genius and untiring energy his works, that after his rest now 
do follow him, undeniably attest: The Medical College of Geor- 
gia, of which he was the founder; the Southern Medical* and 
Surgical Journal, long the only one, and always a most valuhljle' 
medium of interchange of medical knowledge in the South, was 
the creature of his active brain; and now the enterprise and re 
search of our reporter revives and elaborates from its antiquated 
and dusty volumes this signal token that good seed sown, even 
by the wayside, do not always perish, but in due time may spring 
up and bear the richest fruit, bringing forth forty, sixty, or an 
hundred fold! 
I have often tried to avail myself, for the benefit of my pa- 
tients, of the ease, comfort and relief which are attributed to the 
" knee-and-breast posture" by advising them to practice it. I 
was often disappointed; and now I am made aware that the fail- 
ure in relief arose from the fact that "the suction was not broken," 
and because there was not at hand any convenient and efficient 
means of " air-way," such as we now have offered to us in Dr. 
Campbell's simple and most philosophical device, the " pneumatic 
self-repositor."