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TAMPONADE, MORE TAMPONADE, MOST TAMPONADE: WHY IS MOST

TAMPONADE A FAILURE ?

Frances A. Harper, M. D., Pittsburg, Kansas. Two years ago I read a paper before this "In regard to these displacements of the association on Malpositions and Distor- uterus, I have had experience in dealing tions of the Pelvic Organs,” outlining in with them for a good many years under the a general way treatment for their correc- tutorship of a man who was the greatest tion. As the title of my paper gave no packer (?) in the world. He put in as many hint of its character--whether surgical or as twenty-one tampons into one vagina, non-surigcal-and as these conditions are and could get more of them in there than largely viewed from a surgical standpoint, anyone I ever

saw.

He tried out that it was placed in the surgical section. The method thoroughly, and a good many of us warmth of the discussions and adverse have done the same thing. Therefore, criticism voiced by some of the members etc. might lead one to believe that their experi

So, as a practical sequence to my former ences along these lines had been anything, paper I have chosen the title: "Tamponade, or everything, but satisfactory.

More Tamponade, Most Tamponade: Why Quoting from the discussions: “The is Most Tamponade a Failure?” treatment of these uteri with tampons and There certainly must be some good all that sort of thing has never accom. ground for the conclusions reached by so plished a thing. That seems a broad state- many operators who have discarded their ment, but it has taken many years to find former methods of local treatment in favor it out. Operative treatment has grown of surgical measures, some good reasons for with the education and intelligence (save the the unsatisfactory results obtained from mark!) of the gynecologist, and we know such treatment. In my endeavor to discover that it is the only way by which we can ac- if possible, why such conditions might be complish anything in these conditions. reached-why such radical statements could • Read before the Medical Association of the Southwest

be made, and why their treatments had at Kansas City, Mo., October 8, 1913.

failed, so far as ultimate results were con277055

a

vent its recurrence.

cerned, I have here as the result of several tention. Aetius describes various displacemonths of diligent research a fairly good ments of the womb, but says little about history of non-surgical methods of treating treatment, except to mention the kneechest pelvic displacements from the time of Ori- position and the use of the sound. basius (A.D. 326-403), nearly sixteen hun- But Aetius, Oribasius and other ancient dred years ago, up to the present time. Of writers describe the method of treating the course I shall not attempt to read all this, prolapsed uterus "by placing the patient as much of it is immaterial, but will make on her back, elevating the pelvis, pressing

the uterus upwards, and then placing in the vagina a ball of wool, with a string attached to it” (McKay). (Hundreds are still using this very method, with little variation, in treating all sorts of pelvic displacements, even in this enlightened age.)

Vaginal tampons were also used as means of applying medicines to the vagina and womb.

In the Middle Ages prolapsus was treated by the use of solid pessaries, wood and similar materials being used for making them. Pare was the first writer to describe a number of these instruments (1573), but

they were probably used before this time. REPOSITION OF AN ANTEVERSIO-FLEXION.

It was not until the middle of the nineRULE.-The point at which force is applied in overcoming

teenth century that uterine displacements a displacement is the fixation point for its correction. came to occupy an important place in gyne

Observe that the finger is placed behind the cervix in overcoming this displacement. A packing placed at this point al. cology; and at that time the treatment of ter reposition is accomplished, is but a continuation of the force which overcame the displacemert, and will thus pre

these conditions was almost entirely by means of pessaries, many hundreds of dif

ferent forms being used. Webster says of use of a few extracts bearing particularly this period (about 1855-70): "Sir James Y. upon methods of using the tampon in treat- Simpson reintroduced the sound, and ing for the correction of pelvic displace- showed how it could be used with the biments.

manual examination. His pioneer views The statement is often heard that there have been greatly modified, but his work is no branch of medical science which has was instrumental in directing attention to shown such marked improvements, such the need of thorough local examination." rapid advance, during the past fifty years, The tampon was used by a few physicians as that of gynecology-the treatment of at that time, but as indicated by the above diseases of women. I believe that I made quotation, pessaries were used indiscriminsome such statement as that myself, some ately, and often with unsatisfactory results; years ago; but really I think I must have finally, during the 80's the pessary was said it because someone else had said it, generally abandoned in favor of surgical and I wanted to believe it. However, since methods. making this research, I have experienced Percy says: "In the old days, many of somewhat of a change of heart” in this these cases were held in place by the pesrespect; and I want to contradict that state- sary. But in those days the practitioner ment here and now, by saying that, outside was practically ignorant of infections, and of surgical procedures, I cannot see where what was gained by artificial means was we have taken one forward step in methods often lost through the introduction of new of treating for the correction of pelvic dis- infections by the injudicious use of unsterilplacements of women during the past fifty ized sounds, dirty fingers and speculi." years! and I am here to prove my statement. Dr. Goldspohn, in discussing Bold't

The fact of the matter is, we have been paper (1908), says: "The great evils which working round a circle, which leads to no- did occur in conjunction with pessaries, and where, and the imperfect methods of the therefore led the profession to exclude them ancients are still in vogue, and used indis- from use were not due to the pessary, but criminately for all sorts of conditions, with- to the ignorant use, the abuse, of the pesout rhyme or reason.

sary in introducing it as if it were a lever Historical.- In ancient and mediaeval or jackscrew to raise something." medicine, displacements of the uterus, Tampons were advocated as a niethod of other than prolapse, received but little at- treatment in uterine displacements at the

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time when pessaries were so much used; tampon placed in the anterior fornix around but comparatively little attention was paid the cervix." to them at that time, although a few physi

N.B. It will be observed that the common cians always used them. They have always

method used in placing tampons for the corbeen employed as a means of local applica

rection of displacements is as follows: In tion of medication, and as a plug to arrest

treating backward displacements the packhemorrhage. In later years a number of ing is placed "behind the cervix, in the physicians have advocated the tampon as a means of treating uterine displacements, or

posterior culdesac.” In treating forward

displacements, the packing is placed in the as a preliminary treatment before a pessary

anterior fornix, in front of the cervix." is fitted.

If the idea is to maintain or induce the The following notes and quotations indi- given malposition, then the method works cate the various methods of employing the out all right; but, if the object of treattampon:

ment by tamponade is to overcome and corTauszky states that Dr. Nathan Bozeman rcet the displacement, the opposite method of New York City about 1860'advocated the

must be employed. use of vaginal tampons for the treatment of complicated and uncomplicated cases of uterine displacements and adhesions. Taliaferro a southern physician, some years later published a pamphlet advocating the same plan of treatment, but gave no credit to Bozeman. Dr. Bozeman's method was as follows:

In cases of retroflexion or retroversion the patient is placed in the knee-elbow position : Bozeman's speculum is introduced and his larger vaginal blade is made use of, this latter forming the third blade which elevates the perineum and posterior vaginal wall. Tampons of cotton saturated in one or two per cent solution of carbolic acid, pressed out dry, are then introduced into the posterior culdesac of the vagina as high up as possible, depressing it gently with the posterior blade. By a number of cotton tampons similarly introduced in rapid succession, until the vaginal column is

REPOSITION OF A RETRODISPLACEMENT. complete to the perineum. The instruments RULE.-The point at which force is applied in overcoming

a displacement is the fixation-point for its correction. are removed, and the patent is allowed to Observe that the finger is placed in front of the cervix in follow her daily avocation ... Each tam

overcoming this displacement. A packing placed at this

point after reposition is accomplished is but the continuapon has a string attached to it for its easier tion of the force which overcame the displacement, and

will thus prevent its recurrence. removal. The tampon remains for fortyeight hours usually, when it is removed and a vaginal douche taken, and the tam

Dr. Sarah McNutt (1905) uses strips of pon reapplied” (Tauszky).

non-absorbent cotton or wool, packed up

into the posterior culdesac for retrodisplaceDavenport (1898) recommends packing ments, and emphasizes that "the cotton the vagina to relieve retrodisplacements should be gotten well up behind the cervix." with adhesions.

Palmer (1905) says: "a broad tampon of Benjamin (1901) says that in inserting wool, adjusted well up into the posterior the tampon: "In version of the uterus (pre

culdesac, while the patient assumes the sumably retroversion) the patient is placed

knee-elbow posture." in the knee-chest position, thus throwing

Souther (1906) in treating for retrodisthe uterus forward, after which the inser- placements, uses "a tampon that will hold tion of a tampon in the posterior fornix of

the cervix back," but does not state at what the vagina, and encircling the cervix in a point he applies it for this purpose. semicircular fashion, will hold the uterus Bandler in his Medical Gynecology (1909) in its normal position. ... Flexion (pre- advocates the use of glycerine gauze sumably anteflexions) should be treated with * packed thoroughly into the posterior forthe patient in the dorsal position, and the nix, while the cervix is pulled down with

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