The End Results of Vaginal Operations for Genital Prolapse.

THIS discussion originated at a meeting of the North of England Society, held at Liverpool in December 1918. Professor H. Briggs described the treatment of a case of procidentia in a patient, aged 18, by a vaginal operation combined with ventro-fixation. W. Blair Bell deprecated ventro-fixation, but advocated a modification of Gilliam’s operation. W. F. Shaw deprecated abdominal operations for prolapse, preferring the vaginal methods used in Manchester. Other members urged that the end results of these measures should be ascertained and published, and a collective investigation by the Society was suggested. At subsequent meetings this project was developed and the scope of enquiry came in question. I t was proposed to exclude all except cases of complete prolapse, but this was not thought feasible. The term “genital prolapse” has a fairly definite connotation all over the world; and medical men constantly use the word “ prolapse ” as including both so-called vagino-uterine prolapse and so-called utero-vaginal prolapse. In view of these considerations, it was decided at a Council Meeting of the North of England Society in December 1919, that the enquiry should include “cases of ( I ) cystocele, (2) rectocele, (3) prolapsus uteri, and (4) elongated cervix protruding from the vulva,” namely, in two words, cases of genital prolapse. At an ordinary meeting of the Society in Liverpool in October 1920, F. H. Lacey gave a preliminary report on traced cases operated on at St. Mary’s Hospital, Manchester, during the years 1914-1 5-16. Subsequently it was arranged to defer the further consideration of the subject to this meeting. I will briefly indicate the steps by which I was led to the technique I now use, and will give a few figures which indicate the nature of the results secured by it after the lapse of years and under the stress of parturition. I saw some vaginal surgery in Edinburgh in the years 1890-95, under the late Sir A. R. Simpson and the late David Berry Hart. Clarence Webster was then assistant to Simpson, and he returned from a visit to Martin, of Berlin, bringing back certain special instruments, which some of you may remember, designed to facilitate the performance of colporrhaphies. The J Obs Gyn Brit Emp 1921 V-28