UTERINE DISPLACEMENTS AND FLEXIONS.
Bearing in mind the properties of the electric current it suggests itself at once that in this agent we ought to find a powerful adjuvant in the treatment of uterine displacements. but it is hardly possible to make any definite statements in regard to its value, seeing that but few observers who have tested it have furnished us with their results. From what has gone before it is evident that where the displacement is the result of sub involution, seeing that, through the use of electricity we can diminish the congestion and weight of the organ, we may in so far diminish the lia bility to sagging of the uterus; and further, from what is stated further ou, it is apparent that where the displacement is complicated and main tained by adhesions we can through electricity render the uterus more movable; but the real question at issue here is as to whether we are in a position by means of electricity to cure cases of displacement where the causal factor is lack of tone and relaxation of the uterine ligaments. If we can do this then certainly a great step in advance has been made, for unquestionably our routine methods, by tampons and pessaries, while they generally palliate the symptoms the result of simple displacements, only very infrequently result in cure. Tripier has been an enthusiastic advocate of electricity in the treatment of displacements of the uterus. He used the faradic current, inserting one pole in the bladder in case of retro-displacement, and in the rectum in case of anterior displacements, his aim being to restore tone respectively to the utero-vesical, and to the utero-sacral ligaments. While theoretically this method seems plausible, we should not expect much from it practically seeing that we are not here dealing with true ligaments in the sense of bundles of muscular tissue, but simply with folds of peritoneum, containing but few muscular fibres, which are hardly susceptible of stimulation in the sense intended. Where the factor is rather a sagging downward of the uterus from relaxation of the pelvic floor, then, likely enough, vagino-abdominal electrization, by restoring tone to. this floor, may aid in keeping the uterus at a higher level in the pelvis. This question of displacements of the uterus in reference to the value of electricity can only be answered positively as the result of more careful and general application than has vet been the case. Seeing that the majority of displacements are accompanied by congestive phenomena or their sequelm, we are at the present, however, justified in Looking upon electricity as a valuable adjuvant in their treatment.
As regards flexions of the uterus, although here also positive data from many sources are lacking, we are yet in a position to anticipate permanent results from the use of electricity. We have already seen what a powerful
nutrient agent we possess in electricity, and in flexions of the uterus a prime factor in etiology is diminished nutrition of the uterine wall at the site of the flexion. Obviously we have in mind now cases of flexion which are not the result of inflammatory causes exterior to the uterus, but those instances where the distortion is dependent on a weakening, so to speak, of the uterine wall ordinarily at the level of the internal os. In the majority of instances where flexions exist there are complicating factors in addition, and these obviously call for special treatment, and the cases are exceptional indeed where the chief factor is the flexion, when the case presents itself to us for relief. The faradic current is in these rare cases the one which a priori should be selected. In case of retroflexion one electrode may be placed in the bladder against the uterine wall, and in case of anteflexion in the rectum, the object being to stimulate the uterus at the site of the flexion. The other electrode should, where possible, be introduced into the uterus. This is the method which Rockwell favors, and it is worthy of trial particularly, because if it succeeds—and we would emphasize the fact that we are by no means in a position to maintain that it will—the method is devoid of all risk, a statement which is not at all applicable to the treatment of flexions by means of the stem pessary. In the absence of sufficient data from which to deduce any justifiable conclusion, we should prefer to divulse the flexion thoroughly, under the ordinary requisite precautions, and afterwards to stimulate the uterus and improve its nutrition by means of intrauterine faradization.
In regard to prolapsus uteri, seeing that in the vast majority of cases it follows on lesions which call for some surgical procedure, it will rarely be a question of resorting primarily to electricity for relief of the condi tion. In the lesser degrees of descent of the uterus, following chiefly on sub-involution of the organ and of the vagina, we can unquestionably derive benefit by resorting to electricity for the purpose of diminishing the congestion and of restoring tone to the pelvic floor, and here the faradic current or the galvano-faradic should be chosen. In general, how ever, the same opinion may be expressed in regard to the value of elec tricity in prolapsus as held for simple retro- and anterior displacements: while we may palliate the symptoms, we cannot hope to cure.