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September 24, 1898


Author Affiliations

Professor in the Chicago Post-Graduate School of Gynecology and Abdominal Surgery; Professor of Gynecology and Abdominal Surgery in Illinois Medical College; Professor of Gynecology and Abdominal Surgery in Harvey Medical College; Gynecologist to St. Anthony's Hospital; Consulting Surgeon to the Mary Thompson Hospital for Women and Children. CHICAGO, ILL.

JAMA. 1898;XXXI(13):716-721. doi:10.1001/jama.1898.92450130035002o

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GENERAL VIEWS.  As we employ perineorrhaphy to repair uterine prolapse (sacropubic hernia) as well as deficiency of the external sphincter apparatus, the subject covers a vast field. All kinds of genital supports—peritoneal, fascial and vaginal sphincter apparatus—must be considered. To have prolapse, both peritoneal and fascial supports must yield, as well as the occurrence of muscular relaxation. No one support to the exclusion of all others can be claimed for the uterus.The utero-rectal (sacral) ligaments which consist of peritoneal duplicatures, containing fibro-muscular tissue, are very efficient uterine supports. The peritoneum itself, on account of its intimate connection to the pelvic viscera and fascia, doubtless gives considerable support.The round ligament, with its peritoneal duplicature, the broad ligaments holding some muscular fibers, and the vesico-uterine ligaments all assist in supporting the genitals. In the consideration of sacropubic hernia, the intra-abdominal pressure, the state of the abdominal walls, as well as

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