Manchester operation of colporrhaphy in the treatment of uterine prolapse.

U TERINE prolapse is an old Iesion about which much has been written. Among the writings of Hippocrates reference is made to the fact that dispIacements of the uterus were recognized but it was not until the time of GaIen, 130 to 210 A.D., that this condition excited much interest. GaIen also we11 described the condition of proIapsus uteri. According to William FIetcher Shaw,’ MarshaI1 Ha11 of London seems to have been the first to suggest narrowing the vagina in the treatment of uterine proIapse but there is no record that he performed the operation himself. In 1831 Heming operated upon the anterior vagina1 waI1 and was foIIowed by numerous other surgeons, including Marion Sims, Emmet, Aveling and GaiIIard Thomas. Operations on the posterior vagina1 wal1 and perineum were performed by Hegar, Simon, Emmet, Martin and others. The cervix was amputated by Huguier, CoupiI, Sims and others. The I8go edition of Hart and Barbour contains this statement about perineorrhaphy, “These operations heIp, at Ieast by enabling the patient to wear a ring pessary,” and that apparently was the object for which the operation was performed. WhiIe numerous surgeons performed singIe operations on the anterior vagina1 waI1, on the posterior vagina1 waI1 and amputated the cervix, none combined these three operations until some members of the Staff of the Women’s HospitaI attached to the University of BerIin and A. DonaId of Manchester started to do so in 1888. Thus in 1888 A. DonaId of Manchester quite independentIy began to treat cases of prolapsus uteri by the combined operation of anterior and posterior colporrhaphy and amputation of the cervix. Donald’s first two operations were performed on ApriI 28 and JuIy 18, 1888, siIver wire being used as suture material as this was the most commonIy used suture at that time. Hearing that a new absorbable suture material, catgut, was being tried in genera1 surgery in Germany, Donald obtained some of this catgut, sterilized in carbolic oil, and used it in the performance of his third operation on August 3, I 888. He did an anterior coIporrhaphy and approximated the deep tissues with a buried continuous suture of catgut. Two weeks Iater he did a posterior coIporrhaphy using the same technic. The patient was discharged on August 30th and the folIowing discharge note was made: “The wound was heaIed and the outIet of the vagina onIy admitted two fingers with difficulty, no pessary was inserted.” Originally Donald made the denudation of the anterior vaginal wall with a wide diamond-shaped incision; later, W. E. FothergiII modified this by making it triangular in shape, with a wide base near the cervix, and by a circuIar incision around the cervix he combined the amputation of this organ with the anterior colporrhaphy. The result of this modification was the wider exposure of the tissues of the broad Iigaments on each side of the cervix which permitted better and stronger apposition of these structures in front of the cervix.