INTRA-PELVIC TECHNIC (Manipulative
Surgery of the Pelvic Organs)
PERCY H. WOODHALL, M.D., D.O.
Definition and Application
We shall limit the term "intra-pelvic" technic, as nearly as possible,
to,those manipulations applied with the hands directly to the organs and
tissues within the pelvis, though occasionally it may be necessary to describe
other collateral treatment. Its purpose is to readjust and reconstruct
the soft tissues within this region to the end that their functions may
be restored. It is an integral part of the usual spinal and innominate
technic. It presupposes the application of this technic and is by no means
a substitute for it. It is merely a part of the treatment necessary in
many cases and by no means the only necessary measure. It is not presented
as an essential part of every gynecological treatment but as the best way
and often the only way of successfully attacking certain pathological conditions
within the pelvis.
There is a great deal of meddlesome gynecology practiced. We sometimes
forget that every female ill does not originate in the pelvis. So intra-pelvic
technic is not to be used indiscriminately, but only when there are
definite indications for it.
Being an agency of greatest good in selected cases it has possibilities
of proportionate harm if improperly used. Among these possibilities are
the rupture or an abscess, a pyosalpinx, a cyst (if of an infecting character),
the sac of an ectopic gestation; an acute or subacute inflammation may
be aggravated, or hemorrhage may follow the tearing of adhesions.
This technic and its contraindications require the nicest discrimination
and the best of judgment. In no field of manipulative therapeutics is there
a wider field for the expression of knowledge of structure, of skill in
palpation, or a more delicate sense of touch demanded.
The therapeutic value of this measure is enormous and is limited only
by the knowledge and skill of the operator.
Surely if any manipulative technic deserves the appellation of "manipulative
surgery" this does. Nowhere in the body can those conditions ordinarily
demanding surgical intervention, be as successfully treated and surgical
operations prevented by manual technic, as in the pelvis.
Whatever may have been the primary cause of intra-pelvic pathology, whether
tissue maladjustment or normal resistance overwhelmed by the quantity
or quality of an infection, even though this cause may have been
removed, or has ceased to operate, certain secondary conditions
remain. So an inflammation in the pelvis may have subsided but has
left in its wake many injurious sequelae. The removal of these is
of equal importance with the removal of the primary cause, if function
is to be established.