Vol 11, No 9 (1897)

In 1892, in The Doctor, I published my first article — the removal of the uterine appendages and their neoplasms through the vagina. In this article, on the basis of my clinical observations, I recommended for some cases a new surgical method for removing large appendages of the uterus and their neoplasms through the posterior fornix. This article of mine caused only one critical note by Dr. Tipyakov in the same "Doctor" in which he spoke out against this operation. I replied to this article with a second article, also in Physician for the same 1892, in which I proved with new clinical observations the relevance and superiority of this operation before gluttony in certain cases. Then, until 1895, no attention was paid to my proposal, and only from that time, when the question of vaginae fixatio uteri began to be developed in German literature, and then when prof. Dührssen's proposal to remove uterine appendages and some neoplasms of the uterus using colpotomiae anterior, since that time the question of the significance of colpotomiae anterior et posterior for removing diseased uterine appendages and their neoplasms has become fashionable on the pages of the special medical press. At the present time, the literature on this issue is quite large and I will not expound it here, since this issue will be examined in detail in a special work of my friend Dr. P. Ya. Teplov, which will soon appear in print. I currently wish only to summarize my clinical data on posterior colpotomia.

Regarding the vessels, my research yielded results similar to those obtained by other researchers. The vessels of the cellular layer are of particular interest, in particular those of them that, having a large caliber, have only an endothelial membrane (capillaries) or even lack any membrane (Blutlacnnen ѵ. Tussenbroek). The opinions of the authors differ as to the origin of these vessels from arteries or veins, due to the loss of the membranes and their expansion. Dobbert recognizes their origin in arteries, similar to the pregnant uterus and tube. Tussenbroek found that the arteries in the decidua retained their structure, and their branches, without loss of muscle membrane and expansion, came close to the surface. Therefore, she considers the veins to be the source of these vessels. As for my case, I found in the cell layer, in addition to capillaries and blood cavities without a trace of membranes, also branches of arteries with an extremely thin connective tissue membrane, which was especially striking when compared with the membranes of the arteries of the glandular layer. Therefore, I am inclined to recognize the origin of these blood vessels from the branches of the arteries, due to the loss of the membranes and their successive expansion. Thus, we find here a process analogous to that which occurs in decidua serotina during normal pregnancy, as proven by Waldeyer's work, Bohr's, Hofteier's, Gottschalk's and others. The presence of such blood cavities, devoid of their own wall, is the second characteristic feature of deciduae uteriuae during ectopic pregnancy.

During 1894-95. to the obstetric department of the clinic prof. K. F. Slavyanskogo accepted 1527 women in labor, 44 pregnant women and 5 women in childbirth soon post partum. Of the pregnant women, 17 after a certain time were resolved in the clinic, the rest were discharged before resolution in most cases due to the cessation of labor pain. Some of the latter were again admitted to the clinic at the onset of childbirth and were included in the total number of resolved.

There were 24 members: Baykov, Bekman, Buchstab, Dolinsky, Dranitsyn, Zheltukhin, Zabolotsky, Zematsky, Kakushkin, Lichkus, Massen, Matseyevsky, Misevich, Piotrovich, Poroshin, Rachinsky, Rachinsky, Ruchinovsky, Ruchinovsky, Ruchinsky, Ruchinsky, Rachinsky, Fischer, A. R., Schuttenbach and 26 guests.

Earlier, thanks to the authority of Witt, it was assumed that gonococci can develop exclusively in the columnar epithelium, in women it means only on the mucous membrane of the urethra and cervix, while the vulva and vagina remain intact. If they found gonococks in the secret of the vagina, they explained this by the introduction of gonococks from above, from the cervix.

Some authors described nodular small thickenings and enlargements of the pelvic peritoneum during ectopic pregnancy, which were considered especially characteristic of peritoneal pregnancy. Schmorl, who thoroughly studied the peritoneum of the pelvic floor in a number of cases of normal intrauterine pregnancy, soon came to the conviction that these growths are all too often found in the latter and therefore do not constitute anything characteristic of an ectopic pregnancy.

On the basis of 10 cases of caesar section observed in the Zurich clinic over the past 5 ½ years with only one lethal outcome, the author advocates a caesar section, which has recently been somewhat pushed into the background by symphysiotomy.

All authors agree that in order to prevent complications that may arise, an ovarian tumor diagnosed during pregnancy should be removed immediately, because on the one hand, pregnancy does not worsen the prognosis of the operation, and on the other hand, abortion is observed only in a small number of cases (20-22%)

After it has been proven that even among women in childbirth who were not examined during childbirth, the percentage of morbidity (if by morbidity we mean any increase in temperature) exceeds 20 or more, there can no longer be any doubt that a different percentage of morbidity is noticed in different clinics least of all due to the unequally strict application of disinfection rules.

Only with a very speedy birth, strong attempts and a small fetus, both shoulders enter the pelvis simultaneously in a transverse or oblique diameter. As a rule, the shoulders come out according to a certain mechanism.

Given the paucity of our information, not only about the cause of uterine atrophy after castration, but also about the immediate nature of the changes occurring in the structure of the uterus, G.'s work deserves special attention.