I am convinced that they are a great source of evil, and a sure index of ignorance on the part of those who habitually recommend them. The German school of gynecologists have of late years greatly perfected the plastic operations of the vagina, in fact, it is almost a sub-specialty in itself, to which they have given the term prolapse operations. A specialist, who is competent in the details of these prolapse operations, can hold out the very best possible chance for a radical and permanent cure, and while the operation requires a certain degree of skill and special training, which should be obtained by practicing these operations on the cadaver, in order to save time, and not bungle the operation on the living subject, as too often, unfortunately, happens. In skillful hands, the operation is entirely without danger, and under proper antiseptic precautions, the results are very satisfactory.
The question is simply this: If the knee-chest treatment, and the remedies that have been suggested, do not give permanent relief, then there must be some such defect in the pelvic floor as I have heretofore described.
If the vagina is too wide, it should and can be narrowed to its normal dimensions, by removing the excessive tissue; if the vagina is torn into the perineum, this too must be united. Should the cervix of the uterus be abnormally elongated, so that it makes it physically impossible to return it to its natural position, it should be shortened or amputated, and if all these three complications coexist, then an operation combining and remedying all these defects, should be performed at one sitting. This method alone will restore the patient to health and usefulness.
CHAPTER XX.
VERSIONS AND FLEXIONS OF THE UTERUS.
Version, in the nomenclature of diseases of the womb, means that the entire organ without any deflection in its normal axis turns, inclines or leans either forwards, backwards or sidewards.
The prefix ante is used in the sense of forwards and in composition with version we have the word anteversion, which in conjunction with the term uterus, signifies that the organ is inclined forwards. The prefix retro, signifies backwards, and in composition with the word version and in connection with the word uterus, it implies that the womb is turned backwards.
The word flexion differs from version, inasmuch as it signifies a bending or bowing, which breaks the normal axis of the womb. The neck or cervix of the uterus may retain its normal position, while its body is abnormally deflected or bent in any direction. The prefixes ante and retro are also used in composition with the word flexion as they are with version. These distinctions should be remembered.