LIST OF CONTRIBUTORS VOL. XX. OSCAR H. ALLIS, M.D., of Philadelphia. J. M. ANDERS, M.D., LL.D., of Philadelphia. W. EASTERLY ASHTON, M.D., of Philadelphia. REV. LAWRENCE M. COLFELT, D.D., of Philadelphia. J. A. DE ARMAND, M.D., of Davenport, Iowa. GEORGE A. HEWITT, M.D., of Philadelphia. AARON HOWELL, M.D., of Camden, N. J. ROBERT C. KENNER, A.M., M.D., of Louisville, ERNEST LAPLACE, M.D., LL.D., of Philadelphia. ARTHUR E. MINK, M.D., of St. Louis. DRS. ALBERT ROBIN and MENDEL, of Paris, France. THEODORE WILLIAM SCHAEFER, M.D., of Kansas City, Mo. WILLIAM F. WAUGH, A.M., M.D., of Chicago. FRANK WOODBURY, M.D., of Philadelphia. Clinical Lectures. UTERINE DISPLACEMENTS, WITH SPECIAL REFERENCE TO THE TREATMENT OF FORWARD AND BACKWARD DISLOCATIONS.* BY W. EASTERLY ASHTON, M.D., Professor of Gynecology in the Medico-Chirurgical College of Philadelphia. IN considering displacements of the uterus from the stand-point of treatment we must divide all malpositions into those which are of primary and into those which are of secondary importance. Thus, if a displacement is caused by a tumor pushing or to adhesions pulling or it is associated with a pelvic lesion, then the position of the womb becomes a secondary consideration and the case, from the stand-point of treatment, is no longer one of uterine displacement. Viewed, therefore, in the light of this classification, the treatment of uterine displacements narrows itself down to a consideration of only those which are of primary importance. First: The uterus may be displaced, as a whole, in an anterior, posterior, or a lateral direction. Again, there may be descent or ascent of the organ. All these displacements, with the exception of the prolapses, are of secondary importance, being due to tumors pushing or to adhesions pulling. They are, therefore, not to be included in those cases of malposition * Lecture delivered at the Medico-Chirurgical College. No. 1. of the uterus which claim our attention as primary conditions. Second: The uterus may be displaced by version or flexion in an anterior, posterior, or lateral direction. These displacements are all of primary importance, except the lateral versions and flexions, which are, as a rule, caused by pelvic lesions. Third: The uterus may be inverted. This form of dislocation of the organ is of primary importance. We have, therefore, to consider, from the stand-point of treatment, the anterior and posterior versions and flexions, the prolapses, and the inversions of the uterus. The anterior versions and flexions are never pathological, except they cause dysmenorrhoea, endometritis, or sterility, or unless they are associated with a pelvic lesion, in which case they become of secondary importance. The treatment of these forms of displacement is dilatation and curettement of the uterine cavity. This operative procedure relieves, in a certain proportion of cases, the dysmenorrhoea, endometritis, or sterility dependent upon the displacement. Posterior displacements, from the standpoint of treatment, must be divided into recent and chronic cases. By recent cases is understood those which have been displaced less than one year. The practical necessity for this division lies in the fact that after a uterus has been displaced for a considerable length of time the tissues and ligaments have become so overstretched, separated, and degenerated that |