EXPEDIENTS IN GYNECOLOGICAL PRACTICE.1 
JAMES R. CHADWICK. M. D. 
Having always held the opinion that a multiplicity of instruments is but 
a poor substitute for skill, it has been my aim to make the few instruments 
which I habitually carry in my bag answer many purposes. As some of these 
devices may prove useful to others I shall venture to lay them before the 
society. 
(1.) Wool wadding for vaginal tampons and the application of acids to the 
uterine cavity I have found much more serviceable than cotton-wool, because 
it absorbs fluids more rapidly, as you see, and can be wound upon the instru- 
ment more easily, and it never gets matted. If cotton-wool, however, be 
used, its Absorbent qualities may be much increased by boiling in hot water. 
For tampons it will be found occasionally convenient to aflix several to the 
same string, at distances of about three inches. 
(2.) For intra-uterine applications I employ the wire stilets from the com- 
mon English catheter. If the ends of these be roughened with a file, they 
answer the purpose quite as well as the silver instruments with handles, which 
are sold for one or two dollars. If it be desired to leave a wad of wool, sat- 
urated with a styptic, in the cavity of the uterus to check hamiorrhage, this 
may be readily effected by inserting the wire into a catheter, about three inches 
of the closed end of which has been cut off; let the wool then be twisted 
loosely round the protruding end of the wire, soaked in the solution, and in- 
troduced ; if the catheter be then held firmly and the wire withdrawn, the wool 
will be left in the uterine cavity. The catheter and wire are cheap and efficient 
substitutes for Sims’s whalebone staff and silver canula. For the removal of 
such wads from the cavity Dr. Sims has devised a modification of a cork- 
screw, which works well, but may be dispensed with if the operator will simply 
lay a piece of twine upon the wool alongside the wire, and will by careful 
manipulation roll the wool round the two at once ; the two ends of the twine 
then being tied together, the wool is passed into the cavity ; the next day the 
patient can extract it by drawing upon the loop of twine which passes through 
its centre. 
(3.) Uterometer. Many appliances have been attached to the uterine sound 
to mark the distance to which it enters the uterine cavity. This object may 
be perfectly attained with the ordinary sound, when introduced through the 
speculum, by putting a little dab of grease near its end; this will be pushed 
by the external os out upon the instrument, as it enters, and on withdrawal 
will indicate the depth to which the sound has penetrated. Occasionally the 
grease will partially adhere to the os, but by watching it during the withdrawal 
1 Reprinted from The Boston Medical and Surgical Journal of August 2, 1877. 2 
Expedients in Gynecological Practice. 
of the sound it can easily be seen whether the upper or the lower margin of 
the grease marks the length of the uterine cavity. 
(4.) Syringes. In the middle of one night, about a year ago, I was trying 
to check profuse haemorrhage from a carcinomatous uterus by injecting through 
an elastic catheter a solution of liquor ferri perchloridi by means of a hard- 
rubber syringe. I was disturbed to find that its barrel had so warped as to 
allow the fluid to escape round the piston rather than be forced through the 
eyes of the catheter, which were probably plugged with blood clots and the 
tissues of the growth. In this emergency I saved myself a long journey home 
in search of another syringe by unscrewing the cap of the barrel, applying my 
mouth to its open end, and blowing into its cavity while the syringe was held 
perpendicularly. The force of gravity, of course, kept the fluid at the bottom 
of the barrel, whence it was forced through the catheter by the inflation. The 
haemorrhage was at once arrested. Lately I incised a Bartholin’s gland which 
was in a state of chronic suppuration. The pus that issued was so offensive 
that I thought it advisable to wash out the cavity of the abscess. I accom- 
plished this, in the absence of a syringe, by filling my mouth several times 
with water and squirting it through a clean catheter into the cavity of the ab- 
scess. 
(5.) Aspiration, with any of the instruments, is often a tedious process and 
requires considerable apparatus. In removing fluids from the abdominal and 
pelvic cavities, I have partially avoided these obstacles of late by using the aspi- 
rator needle with simply a long rubber tube attached. By allowing the latter 
to hang down I make a siphon, which exercises considerable aspiratory action. 
The flow is of course started and maintained for some time by the abdominal 
tension, supplemented by pressure of the hands or of a swathe. Regurgita- 
tion, which might be feared toward the end of the operation, with the introduc- 
tion of air into the evacuated cavity, is prevented by letting the end of the 
tube lie beneath the surface of the fluid in the basin. 
A common Davidson’s syringe, affixed to the canula and allowed to hang 
down, will act in precisely the same way, while the flow may be accelerated by 
squeezing the bulb, as has been pointed out by Dr. Flint in connection with 
tapping the chest. 
That the simple tube will answer for all fluids from the abdomino-pelvic 
cavity, except the thick mucilaginous variety of the ovarian fluid which can 
never be extracted by aspiration, I can affirm from experience. 
(6.) Rubber tubing of various sizes I never fail to carry in my bag. Little 
pieces of it drawn over knives and trocars protect their edges and points 
much more efficiently than corks, and do not fall off so readily. 
(7.) This knife (instrument shown) on a long staff is designed for operations 
in the interior of the womb ; I protect the cervix or, if no speculum be used, 
the vagina by passing the blade into a rubber tube through a longitudinal in- 
cision at about its middle ; the tissues are thus jmotected from the sharp edge 
during the manipulations necessary to bring the knife into the proper position ; 
by the free end of the tube, which projects from the vulva, I then drag the 
tubing up the staff of the knife, uncovering the blade. 
(8.) I used to be much troubled by the sticks of solid nitrate of silver not Expedients in Gyncecological Practice. 
3 
fitting my holders, and by their breaking when the ring was forced down. By 
pushing them into piecesl of tubing of suitable size and cutting off enough of 
the latter to uncover their points, I make them fit the holder and preserve 
them from being broken. 
(9.) Urethral Dilators. I have rarely had difficulty in dilating the female 
urethi’a with my fingers, beginning with the little one; but on several occasions 
the outer half of the urethra has been so unyielding, owing to chronic urethri- 
tis, as to resist all my efforts. In the first case I overcame the resistance by 
inserting dressing forceps, such as are specially adapted to general gynaecolog- 
ical purposes by the narrowness of the blades and the lengtfi of the handles, 
and opening them forcibly. This procedure effected the object, but the blades 
kept nipping the walls of the urethra, and their tips caused considerable lac- 
eration of the canal. To obviate these casualties, I next time passed the 
blades into a piece of tubing through a longitudinal slit two inches from its 
end; the instrument, thus protected, could be opened very wide without the 
possibility of injury to the urethra; the free end of the rubber can be held so 
as to prevent its accidental escape into the bladder. Although this improvised 
dilator may not be quite so convenient as Simons’, yet it will prove a very handy 
substitute. 
(10.) Elastic Pessaries. The well-known rings of watch-spring, covered 
with soft rubber, have been popular because of their comparative harmlessness 
and the ease of their introduction. The chief objection to them is their dilat- 
ing the vagina so much laterally as to shorten it in length, and if they are 
long worn they weaken its walls. To prevent this lateral distention I one day 
slipped on a common rubber band, which worked well as far as the pessary 
was concerned, but was found, two weeks later, to have nearly amputated the 
cervix uteri by the friction of its sharp edge. For the band I substituted a 
ring made of tubing by pushing its two ends over a piece of an English cath- 
eter about three fourths of an inch long, and of the same size as the tubing. 
This improvised elastic band had, of course, no edge which could cause ulcer- 
ation by pressure or friction, but would slip off the pessary when the latter had 
been lubricated by oil or the natural secretions of the vagina. A piece of silk 
tied round the apposed portions of the band near the ring at each side ren- 
dered it immovable, and gave me an instrument which acts admirably in many 
cases where Hodge’s pessary and others are contra-indicated by the presence of 
a hymen, a tender prolapsed ovary, etc., etc. 
I offer this pessary to general practitioners as being very efficient and per- 
fectly safe. Though I believe that specialists are best qualified to choose the 
pessary which is adapted to an individual case, yet I deem it all impor- 
tant that every practitioner should be able to treat any ordinary displacement 
of the womb; for this purpose it is desirable that he should have a pessary 
that is easy of insertion and harmless in its operation, even if it be not quite 
so well adapted to support the uterus, as more complicated and harmful in- 
struments.