THE LACERATED CERVIX. 
By W. G. BOGART, M. D., Chattanooga. 
PROFESSOR OF DISEASES'TTF*'CV'6\IEN, CHATTANOOGA MEDICAL 
COLLEGE. 
Read before the Tri-State Medical Society of Alabama, Georgia and Tennessee. 
There is no department of medicine that has received more 
attention or made more rapid progress in the last quaiter of a 
century than the branch of gynaecology, and it has been only 
through the untiring energy and labors of such men as Mc- 
Dowell, Sims, Thomas, and our own much esteemed Battey, that 
today we stand as American surgeons at the head of the pro- 
fession of medicine. 
It is my intention today, to speak of a not infrequent acci- 
dent, and especially the treatment, for which we are indebted to 
Dr. Emmett, ot New York, “The Lacerated Cervix.” It was 
not until after he had written his paper in 1862, entitled “Prin- 
ciples and Practice of Gynaecology,” that this subject has at- 
tracted any special attention in the profession ; but especially in 
his first paper on this subject in 1869, we find that the attention 
of the practitioner has been attracted as much, if not more, to 
this subject than any other. It has been found that by its exist- 
ence many pathological conditions have followed as a natural re- 
sult. At first, of course, we have nothing but a simple wound, 
which may heal more or less rapidly, according to the greater or 
less amount of cleanliness. Under very favorable conditions we 
may have union to take place by first intention, but a perfect 
union, however, is very rare. There is usually a certain amount 
of cicatricial tissue under circumstances of this kind, which has a 
less supply of blood than we normally find, and the nerve supply 
is found in most cases to be either abnormally furnished, or there 
is a marked exaltation of function. We frequently find the cer- 
vix painfully sensitive to the touch, which is due either to the 
jarring of a nerve, or likely to a cellulitis or peritonitis existing. 
With these conditions we may have hypertrophy, cystic degen- 
eration, bringing along with it a multiplicity of symptoms, which 
by many are diagnosed as diseases. The symptoms by which we 
may suspect, or even with some degree of certainty diagnose, a 
laceration, are many. I may say that laceration may exist for a time without exciting enough attention for the patient to know 
that anything with the pelvic organs is wrong, but it is not until 
after it has reached a chronic form that the symptoms begin to 
point to the pelvis as the seat of trouble. We find this patient 
pale and haggard, and she complains of dragging sensations in 
the hips and loins. Most often she will have a sanguineous dis- 
charge, or of leucorrhoea, no appetite, digestion variable, de- 
spondent, sleep disturbed and bowels constipated. Many of you 
may think that I have overdrawn the line of symptoms pointing 
to a laceration, but when we consider the many pathological con- 
ditions which likely exist at-the same time, we are not surprised. 
Subinvolution, areola, hyperplasia, often some of the displace- 
ments, together with cervical degeneration, with an exiting 
vaginitis, urethritis, and along with these conditions probably 
menstrual disturbances, in some instances amenorrhrea, while at 
other times we may have menorrhagia, or metorrhagia, which is 
by far the most frequent. Often repeated miscarriages is another 
condition which is not at all uncommon, while on the other hand 
we may have sterility as the resfilt of laceration. There is a long 
line of nervous conditions which is either directly or indirectly 
■due to this condition. 
Dr. Emmett says the importance of a lacerated cervix can- 
not be exaggerated, since one-half of all the ailments of those 
>who have borne children are to be attributed to the laceration of 
the cervix. This statement is substantiated by men of equal 
•eminence, as well as by many general practitioners ; and it is a 
statement not to be disputed, that the lacerated cervix together 
with the many complications which are certain to follow, is the 
source of much suffering, disappointment, and I might say, un- 
happy homes. 
Since this is true, let us see what can be done for the unfor- 
tunate individual who may be suffering from this condition. 
Understanding it as we do, we see that we have a physical 
wreck as well as a local lesion. For convenience let us divide 
the treatment into preventive, preparatory and operative. 
Preventive treatment more properly belongs to the obstetri- 
cian, and if prevented at all must be prevented at the time of 
confinement. We all know that often a laceration of the cervix 
cannot be avoided, no matter how skillful we be ; but we do 
know that there are some things done often which make it very 
much more liable to occur. The administration of ergot, the 
untimely use of the forceps, the rapid dilation of the os by arti- 
ficial means, and I might say by a general unskillful and meddle- 
some manipulation. As to the preparatory treatment, much can be salid, for in 
the proper preparation of our patient depends the entire success 
of labor; and just as the wise farmer would first prepare his soil 
before sowing his seed, so a wise physician will first prepare the 
system before attempting to repair this local lesion. 
General tonics, nutritious diet, open air, appropriate laxa- 
tives and local preparatory treatment should command our atten- 
tion. Iron, quinine and strychnia, together with vegetable ton- 
ics, would be found very useful, a tonic laxative being required 
in most cases, as constipation is one of the conditions which 
usually exist. 
As to the preparatory local treatment, much can be done by 
the use of wool .or cotton tampon, the wool being preferable. 
The tampon may be soaked in glycerine, boroglyceride or glycer- 
otannin, glycerine and iodine. Blood letting by puncture, 
Churchill’s tincture of iodine, iodized phenol, and the use of a 
large amount of hot water for their stimulating effects, would be 
some of the means preparatory to the operation, if any operation 
be necessary. 
While I would not attempt to detract ftom the operation 
any of its usefulness, when needed, I am opposed to the too fre- 
quent use of the knife in these cases, just as I am in many 
others. My reading, as well as my experience, teaches me that 
it is best in a large per cent, of cases to try other measures first. 
Dr. W. Gill Wylie said that a lacerated cervix should not be 
sewed up until it gives rise to symptoms; and that when it does 
produce symptoms, there is some disease behind that needs treat- 
ment. Dr. Paul F. Munde, in the same discussion, said that he 
never considered a laceration with regard to operation unless it 
produced symptoms. Its mere existence does not call for sewing 
up, no matter how large it may be, or how much everted. Dr. 
A. E. Currier says : “I decline more and more to perform the 
operation.” Dr. Emmett says : “I think sometimes that more 
harm than good has been done by the operation, although in so 
many cases there is no operation that can take its place or ac- 
complish so much.” He further states that where we have sub- 
involution or a thickened condition of the broad ligaments, that 
the case must be properly prepared before the cervix should be 
operated upon, and until the preparatory treatment has been car- 
ried out it is impossible to say what cases require operation and 
what do not. Dr. Battey corroborates the above statement as to 
frequency of operating upon the cervix, and states that where 
he used to operate a number of times, he now only operates 
upon the cervix a few times. But that we have cases that require trachelorrhaphy is cer- 
tain. The day before the operation, it is good practice to thor- 
oughly move the bowels with a laxative. The patient may be 
anaesthetized ; however, this is not necessary. The patient is 
placed in a Sims’ position and the vagina dilated as large as 
necessary to bring the cervix in view. The neck is seized with 
a Vulcellum forceps and drawn until the lips can be transfixed 
from before backward, with a strong needle armed with a double 
thread. The threads are drawn through far enough to form two 
loops; these loops are left long enough to pass out of the vagina 
several inches, and by them we are able to completely fix the 
cervix, or change the position at will. The loops may be held 
up by an assistant; a small tenaculum may be used to hold the 
cervix in position. 
These preparatory steps having been taken, the operator 
seizes the edge of the laceration with the tenaculum and pares 
off all the cicatricial membrane. The entire cicatricial surface 
should be removed, seeing well that the angles are thoroughly 
pared. After this is completed and the haemorrhage has been 
overcome, we take our stitches, beginning about one-eighth 
of an inch from the incision on either side of the flap. The 
needle is passed perpendicularly through to a point that will in- 
clude the same distance in the endocervical membrane. To this 
thread should be attached a silver wire eight or ten inches long 
drawn through and held by an assistant, until all are placed in. 
Before twisting the wire the edges of the wound should be 
cleansed of all clots, and the wires should then be twisted evenly 
Catgut, silkworm gut or silk thread are equally as good as the 
wire. After the operation the vagina should be thoroughly 
cleansed and the patient placed in bed. Of course antiseptic 
measures have been carried out fully. 
It would be well here to consider some of the causes of fail- 
ure in obtaining a perfect result. 
First, an imperfect performance of the operation. But the 
most frequent cause of failure is an imperfect preparation of our 
patient. These, with the management of our patient after ope- 
rations, are the chief causes. 
The patient must remain quiet, and the bowels should not be 
moved for at least three or four days. Strict attention to the 
evacuation of the bladder ; light diet, and for the most part liquid; 
the vagina kept clean by warm water injections two or three 
times per day. The sutures should be removed in about ten days, 
and the patient allowed to take moderate exercise for a time.