INTRA-PELVIC TECHNIC (Manipulative
Surgery of the Pelvic Organs)
PERCY H. WOODALL, M.D., D.O.
TABLE OF CONTENTS
I. DEFINITION AND APPLICATION
Direct Manipulation, Purpose, Integral Part of General Technic, Not
Essential in every Gynecological Treatment, Possibilities of Harm, Knowledge
and Skill Demanded, Manipulative Surgery, Removal of Secondary Conditions.
II. INDICATIONS AND CONTRAINDICATIONS
Displacements, Lessened Mobility, Subinvolution, Metritis, Ovaritis,
Salpingitis, Passive Pelvic Congestion, Inflamed and Obstructed Ureters,
Pregnancy, Malignancy, Tubercular Inflammation, Confined Pus, Ectopic Pregnancy,
Acute Inflammation, Menstruation, Fever.
The Pelvic Cavity, The Uterus, The Ovaries, The Uterine Tubes, The
Vagina, The Bladder, The Urethra, The Ureters, The Pelvic Colon, The Rectum,
The Small Intestines, The Parovarium, The Pelvic Connective Tissue, The
Peritoneum, Blood Supply (arteries, veins, pelvic plexus), Nerve Supply
(ovarian plexus, hypogastric plexus, cervico-uterine ganglion).
Intra-pelvic is Final Examination, Not Necessary in every Case, Demanded
by Certain Conditions, Rectoabdominal Examination in Virgins, Inspection,
Position, and Preparation for Examination, Palpation (of vagina, cervix,
uterus, ovaries, uterine tubes, ureters ), Recto-abdominal Palpation, Recto-vaginal-abdominal
Palpation, Examination in Erect Posture.
Causes, Relationship of Deranged Spinal Innervation, Occurrence in
Peritoneum and Connective Tissue, Gonorrhoeal Inflammation, Inflammation
due to Pus Germs, Differentiation important in Treatment, Reflex Effects,
Symptoms (variable, pain, disordered menstrual function, leucorrhoea, sterility,
constipation), Diagnosis, Biananual Palpation, Diminished Mobility, Pain,
Pelvic Mass, Treatment, Restoration, of Motion, Methods, Force and Frequency,
Relief of Pain from Treatment.
Definition, Agencies Maintaining Normal Position, Pelvic Floor, Adjacent
Organs, Abdominal Walls, Uterine Ligaments, Position, Size and Weight of
the Uterus, Varieties of Displacements, Lateral Displacements, Diagnosis,
Treatment, Upward Displacements, Causes, Torsion of the Uterus, Anteflexicn,
Varieties, Frequency, Two-fold Pathology, Causes, Symptoms, Diagnosis,
Treatment, Anteversion, Definition, Causes, Pathology, Symptoms, Diagnosis,
Treatment, Method of Replacement, Backward Displacements, Varieties, Causes,
Pathology, Symptoms, Diagnosis, Treatment, Methods of Replacement, Downward
Displacements, Degrees of, Relation of Pelvic Floor, "Settling of the Uterus,"
Causes, Pathology, Symptoms. Diagnosis, Prognosis, Treatment.
Chronic Endometritis, Causes, Pathology, Symptoms, Diagnosis, Prognosis,
Treatment, Salpingitis, Cause, Pathology, Symptoms, Diagnosis, Treatment,
Chronic Ovaritis, Causes, Pathology, Symptoms, Diagnosis, Treatment.
VIII. TAMPONS AND PESSARIES
Tampon, Purposes, Materials, How Made, Medicaments, Introduction, Pessaries,
Artificial Supports, Useful Devices, Materials and Forms, Support Tissues,
Fitting, Rcshaping, Special Application, Introduction, After Care.
Literature upon the manual treatment of pelvic pathology is surprisingly
meager. It is by no means a new subject. During the same years two men
in widely distant parts of the world were developing the treatment, Major
Thure Brandt (1822-1895) a layman and an officer in the Swedish army and
Dr. Andrew Taylor Still (1828-1917) an American physician.
These men were developing the treatment along different lines. Major
Brandt, decording to his training, along the lines of gymnastics and massage.
Dr. Still with his newly discovered principle that mechanical perfection
is the chief element in the maintenance of health, along the lines of mechanical
adjustment of bodily structure. Nor did Major Brandt give any consideration
to spinal maladjustment, with consequent disturbance of spinal innervation,
as being related in any way to pelvic pathology.
So the teachings of these two men and their followers are related as
massage is to osteopathy. Massage is by no means useless but is merely
an adjunct. It lacks the definite, specific ideal of adjustment (the essential
principle of osteopathy), but is sometimes useful as a means to accomplish
With a desire to aid in the further development of this most valuable
therapeutic measure the following pages are presented.
PERCY H. WOODALL, M. D., D. 0.
Birmingham, Alabama November 25, 1925.