DISPLACEMENTS OF THE UTERUS; 
TOGETHER WITH 
FORMULA FOR OFFICIAL DILUTE HYDROBROMIC 
ACID OF THE UNITED STATES 
PHARMACOPEIA. 
BY 
DE WITT CLINTON WADE, M.D., 
HOLLY, MICHIGAN. 
[Reprinted from the “Transactions of the Ninth International Medical Congress,” Vols. II and III.] 
PRESS OF WM. F. FELL * CO., 1220-24 SANSOM ST., PHILA., PA. Dr. DeWitt Clinton Wade, -Holly, Mich., read a paper on— 
DISPLACEMENTS OF THE UTERUS. 
DEPLACEMENTS DE L’UTERUS. 
LAGEVERANDERUNGEN DES UTERUS. 
The propositions presented in this paper are based upon the studies involved in the 
application of nearly 3000 uterine supporters, each instrument being designed and 
constructed by myself to meet the requirements in individual cases in a private practice. 
This experience is undoubtedly unique, and it is capable of inducing pronounced 
views, irrespective of the impressions derived from other sources. 
1. Uterine displacement exists more frequently than any other disease of the female 
sexual apparatus, and very often commences at puberty. 
2. In the normal subject, the axis of the uterus is at nearly a right angle to the 
axis of the vagina, the cervix uteri not encroaching upon post-vaginal tissues. 
3. Deviations from the normal position of the uterus, either per se, or by influ- 
encing adjacent structures, are capable of inducing, and generally do develop, local 
and reflex discomforts that often amount to complete invalidism. 
4. The causes may include predisposition, inherited or acquired, and they gener- 
ally include the application of mechanical influences, consisting of excessive and ill- 
timed muscular action, as in stair-climbing, lifting, overwork, and constipation; but 
perhaps most of all, of a narrowing and elongating the waist by modes of dress. To 
these must be added the sequelae of child-hearing. 
5. The principal subjective symptoms that direct to physical investigation are back- 
ache, including the shoulders, neck and back of the head, irritation of the organs 
adjacent to the uterus, bearing-down, reflex nervous conditions, that particularly 
impress the functions of the brain, eyes, heart, stomach, kidneys, and the muscles, 
and a condition not easily technically described, having a multiplication of variations, 
extending from unamiability to insanity, and probably best understood by the term 
‘ ‘ nervousness. ’ ’ 
6. Physical examination is absolutely required to complete the diagnosis, by one 
who is familiar with the late advances in the study of the relations of the female pelvic 
organs. 
7. Neglect to verify the probability of uterine displacement by touch, and the treat- 
ment of the subjective symptoms as so many diseases, is the rule with the great body 
of the medical profession. / 
8. The relative frequency of uterine displacement, is about equally distributed from 
the commencement of womanhood to old age. 
9. Ante version generally affects younger subjects than does retroversion. 
10. A displacement for which I have seen no name in the literature is often found, 
where the angle of the axes of the uterus and vagina remains normal, while the uterus 
recedes toward the sacrum, even to a firm impingement of the cervix against the post- 
vaginal tissues. The term retrocession would, in my opinion, be quite applicable to 
this form of displacement. 
11. In retrocession, the normal axis of the vagina approaches the uterus toward its 
fundus, instead of meeting the uterus at its cervix. 
12. It not infrequently occurs that the patient’s subjective symptoms are too trivial 
to suggest that the cause of very pronounced reflex disturbance may reside in that 
PROPOSITIONS. locality, and in the case of young women this circumstanoe, almost universally, 
becomes a harrier to rational treatment, with a failure of recovery. 
13. Pain in the back of the neck and head, aggravated by conditions capable of 
intensifying a displacement of the uterus, is a pathognomonic symptom. 
14. That it is desirable to restore displaced pelvic viscera to normal positions, and 
that such restoration, if accomplished in an unobjectionable manner, is capable of 
terminating the local and reflex disorders depending upon the displacements, cannot 
have a shadow of a doubt. 
15. It is unphilosophical to attempt to correct a displacement with medicine. 
16. When the lacerations of childbirth cause uterine displacements, a restoration 
of the injured tissues, by plastic surgery, gives very gratifying results. 
17. The treatment of the displacements of the uterus by methods of the text-books, 
has proved anything but successful. 
18. The withdrawal of existing setiological factors is doubtless desirable, but this 
alone cannot take the place of physical restorative efforts. 
19. The temporizing expedient of attempting to retain the uterus in place by tam- 
poning the vagina with cotton wool, in anticipation that in a few days the organ will 
permanently remain in a correct position, is not founded upon a reasonable theory, and 
is a failure in practice. 
20. The mechanical treatment of uterine displacement by means of intra-vaginal 
appliances, is indicated in the great majority of cases, and the market is supplied with 
innumerable devices designed for this purpose. 
21. It is almost the universal custom with those who attempt the mechanical treat- 
ment of uterine displacement, to do so with ready-made instruments. 
22. On account of the great diversity of anatomical and pathological conditions 
existing with the female viscera, the mechanical treatmept of the displacements of the 
uterus becomes much too complicated to permit a desirable degree of perfection to be 
reached in the use of the instruments at the command of the profession, and the attempt 
is quite likely to result in abandonment. 
23. It is not possible to restore a displaced uterus to and maintain it in a normal 
position by means of a stem and ring, to encircle the cervix, which can be readily 
understood by recalling the normal relations of the vagina and uterus. 
24. In retroversion of the uterus, the support is generally applied to the vagina 
behind the cervix, and in anteversion and retrocession, the place of contact for 
mechanical support is usually in front of the uterus. 
25. On either side of the urethra, within the vagina, is a recess suitable for the 
reception of the lower end of the instrument in contact with the unyielding pubic 
arch. 
26. The local and reflex symptoms are not proportionately relieved by the use of 
instruments inadequate to the complete establishment of a normal position of the 
uterus. 
27. It is unusual to secure accuracy of adjustment by any method not involving 
the construction of an instrument for each individual. 
28. After many experiments with different materials, I devised and adopted the 
plan, fifteen years ago, of shaping the instrument from No. 10 copper wire, and cover- 
ing it with pure rubber tubing made for the purpose, with thick walls. The tools re- 
quired, are a pair of bending pliers, a wire cutter and a flat file. 
29. Any required device can thus be made, with as much delicacy in the shading of 
its contour as the indications in the case may demand. 
30. There are two designs that I have devised, which I may show for illustration, 
that, in varying proportions, represent the principal requirements in the mechanical 
treatment of the displacements of the uterus. 31. It will be observed that provision is made for avoiding pressure against the 
urethra, bladder, cervix uteri and rectum, thus securing a maximum of freedom from 
discomfort. 
32. Adhesions are not contraindications to replacement of the uterus by a gradual 
method, commencing with an instrument that alfords a light pressure, and as the tis- 
sues yield, exchanging for instruments of increased dimensions, until a normal position 
is reached. I have seen most unpromising cases completely relieved by the use, in this 
manner, of a dozen instruments. 
33. Il|is never necessary to use a uterine repositor, for a supporter that will retain 
the uterus in good position will replace it in a better and safer manner than any other 
instrument. 
34. One of the pleasant results of the successful treatment of uterine displacement 
is its cosmetic effect; removing the otherwise incurable discolorations of the skin, and 
restoring a youthful and vivacious expression to one who has the prematurely jaded 
and aging appearances associated with long suffering. 
35. It is impracticable and uncalled for to discriminate, on sentimental grounds, 
against the rational treatment, without delay, of young women who suffer from the 
local or reflex effects of a displacement of the uterus. 
36. In a large proportion of cases the efficient restraint of the uterus, for a period 
varying from six months to two years, is followed by a radical cure of the displacement. 
37. With one who has been brought into close intimacy with the exacting and 
unyielding effort required to maintain a uterus that has become displaced in a position 
that permits a cessation of the sequelae, no treatment will appear rational not involving 
the application of mechanical principles, 
38. It is certainly true that, on account of the defective measures in treatment at 
their disposal, many distinguished members of the profession have assured their 
patients who were suffering from displacement of the uterus that the effects of such a 
condition had been exaggerated, and its treatment was undesirable. 
39. To close, I must say that he who follows the plans I have indicated will be 
relieved from the sense that the displacements of the uterus are exasperating opprobia 
of the profession, and will adopt a line of labor the results of which will' be at once 
refreshing and delightful.' FORMULA FOR OFFICIAL DILUTE HYDROBROMIC ACID OF THE 
UNITED STATES PHARMACOPOEIA. 
FORMULE POUR L’ACIDE HYDROBROMIQUE DELAYE OFFICIELEMENT DE LA 
PIIARMACOPEE DES ETATS UNIS. 
FORMEL FUR DIE OFFICIELLE VERDUNNTE BROMWASSERSTOFFSAURE DER 
PHARMAKOPOE DER VEREINIGTEN STAATEN. 
DE WITT CLINTON WADE, M. D., 
In 1874 I produced hydrobromic acid by the decomposition of bromide of potassium 
with two equivalents of tartaric acid, and immediately commenced the study of its 
therapeutic properties. My first paper appeared in the Peninsular Medical Journal 
(Detroit), in February, 1875. Previous to these dates this acid had not been made by 
this process, and had never been used or written upon as a medicine. It is now in 
general use in all countries, and the therapeutic and pharmacological literature regard- 
ing it has been many times enriched in all languages. My original formula, which 
was designed to make each fluid drachm of the finished product represent ten grains 
of bromine, was published thousands of times, and I have reason to believe is in general 
use to-day. The last revision of the United States Pharmacopoeia made dilute hydro- 
bromic acid official, and its strength equaling ten per cent, of acid. Since this revision 
I have seen no formula published for the production of the official acid by the decom- 
position of bromide of potassium with tartaric acid. As the requirements of the Phar- 
macopoeia give an acid representing only about sixty per cent, of the amount of bromine 
contained in my formula, and as I am quite sure, from a personal examination of the 
subject, that there is a great lack of uniformity in the strength of the acid being dis- 
pensed in this country, it would appear none too early to present a formula for the 
production of the official acid that is at once the simplest to adopt, and as has been 
shown by years of application, is free from objectionable features. The formula is as 
follows:— 
Holly, Michigan. ■ Bromide of potassium four (4) avoirdupois ounces. 
Tartaric acid five (5) avoirdupois ounces. 
Water seven (7) fluid ounces. 
Dissolve the salt in the water, and add the acid. When thoroughly mixed set aside 
in the cold, for the precipitation of the resulting bitartrate of potassium. Decant the 
supernatant fluid and dilute it with sixteen fluid ounces of water. The result is a ten 
per cent, solution, by weight, of hydrobromic acid. 
Take of—