bark, &c. &c.

If you will take my advice, you will not reject the resources of your art.

them from among

Half a dozen of them, prepared by the patient herself, who is supposed to be never disjunct from the needle and scissors, would last as many days.

I am hardly willing to burthen these letters with descriptions. of the other sorts of pessaries. Yet I ought, perhaps, to protest against the sponge, most particularly against the sponge. It is a tampon. I have, in my long lifetime, had too many occasions to use the tampon, not to have learned what a foul and fetid thing it is after having passed only twelve hours, bathed in animal fluids at a temperature of 95° or 96°. I protest against its employment as a pessary, not only on account of its irremissible fault of uncleanness, but for the additional objection of its irritating nature; the points of the sponge could not fail to vex and fret the mucous tissue of the vagina.

Pessaries are also made of pieces of cork cut into oval or circular discs, and dipped repeatedly in melted wax, until a sufficient coating of the wax being imposed, they are adjusted beneath the uterus to retain it at its due height in the pelvis. Similar instruments are also prepared by coating a tissue with varnish consisting of boiled linseed oil, after the manner of the French bougie or catheter. They are also objectionable as liable to change, and to infiltration. The wax coming off from the cork, leaves its scabrous surface in contact with the living tissue of the womb or vagina, to their great damage or ruin, while the accumulation of putrescible fluids about them might well serve to provoke the attack of dangerous fever.

You will find a capital, cheap, and commodious pessary in one. of the little caoutchouc bottles that you can buy for ten or twelve cents at any of the apothecaries. This is the pessary recommended by Dr. Hervez de Chégoin, in a paper on retroversion, read at the Royal Academy of Medicine, and which I have already spoken of.

Procure such a gum-elastic bottle, about two inches in diameter, and without cutting off the neck, pack it full of finely-carded wool. Take care merely to distend it well, not too much, for it is desirable to have it very soft and elastic. After filling it so as to give it permanently the requisite form and size, be very careful to tie up the neck of the bottle so securely as to remove all danger of

the wool being penetrated by the excretions of the vagina. If you allow those fluids to get inside of the bottle, they will suffer a horrible putrefaction. Leaving the neck sufficiently long, the pessary will maintain its position, because the cylindrical neck being directed towards the os magnum, will keep the instrument steadily in situ. You can cut a solid piece of caoutchouc into the shape of a phial-cork, and stopping the neck of the bottle with it, secure it there with gum-elastic cement, which seals it hermetically. I prefer the stuffed one to the inflated one of Doctor. Hervez.

It may be worn long without changing. It is soft, light, elastic; and, therefore, suitable for some cases in which the metallic resistance of the globe or ring, or elytra, would be painful. For the poor it is cheap-and perhaps it is, on the whole, nearly as good an instrument as a silver-gilt one. These bottles have a neck from half an inch to three-quarters of an inch in length. If you should prefer one of them, after you have filled the bottle with carded wool, which you can press into it so as to give it any shape you may prefer, should you have no gum-elastic cement at hand, you might put a short velvet cork in the neck of the bottle, and drawing the gum-elastic over the cork, tie it so as completely to exclude the air and to prevent the entrance of any of the fluids of the vagina within the bottle. The neck of the bottle being directed towards the vulva, there is no risk of the instrument changing its position.

I had some time charge of the health of an old lady here. She was 85 years of age, and had long endured the inconvenience of a procidentia. The perineum and the levators were without tonicity, and no globe nor disc could she wear, as they instantly escaped on account of the relaxation of all the parts. She was for years of her decline made comfortable, as to her prolapsus, by means of a ring pessary.

She took a long slender whalebone, bent it into a ring of near three inches in diameter; then wrapped it, or as the sailors say, served it with bobbin, so as to give it proper size and firmness. She then dipped it in melted wax again and again, until it was completely and sufficiently coated with the wax. This ring she adjusted within the vagina, and maintained by its aid the womb in the pelvis.

Another woman employed a common umbrella ring for her.

prolapsion, and wore it for years à l'insçu de son mari. It might happily have been denominated the Gyges pessary.

Pessaries are never to be introduced except after a careful inquiry with a view to ascertain the state and wants of the tissues affected. A gentleman informed me, in the street, that he had a very singular case of prolapsus uteri-that the vaginal cervix was enormously swollen, and that he had in vain tried repeatedly to discover the os uteri. He feared that some very extraordinary state of things must be present to alter so completely the form of the parts.

She

"What are you doing for your patient?" said I to him. "Why, I have tried the pessary, but without any success. cannot retain it at all; it comes away, and, moreover, gives her great pain."

"How are her strength and health?"

"Oh, very weak; she has the most violent menorrhagia, and has become, in consequence of it, much reduced and perfectly blanched."

"Go," said I, "to your patient again, and make a careful examination. You shall find that your enormous cervix uteri is not a cervix, but a polypus that fills up the vagina-that bleeds, and that has no os uteri."

He took my counsel, repeated his diagnostic exploration, and came to say that it was truly a polypus. Upon the extirpation of the tumor by means of Gooch's double canula, the hemorrhages ceased, and the lady recovered good health without any prolapsion.

I relate this case for your warning; because the gentleman who made the mistake, is a person of the most elaborate medical education, both theoretical and clinical. You, who are young and inexperienced, will be vastly more likely to make such bévues than he. And indeed! it is curious to think how many strange, ridiculous misapprehensions one meets with among the brethren in regard to women's maladies. It seems to me that the delicacy of the relations existing between the sexes must have the effect of blinding some persons to the plainest and the most diaphanous truths and facts.

There is a kind of pessary, called the pessary en bilboquet by the French, but which is properly, in English, denominated the stem-pessary. Such an instrument is indispensable for the com

fort of those who, having lost all sphinctorian, elevative, and perineal force, can not retain within the walls of the pelvis, either the reproductive organs, or the fine instruments introduced to serve the purpose of an obturator or diaphragm.

Dr. James Blundell, of London, furnished such an instrument to a patient of mine, who had long suffered with prolapsus and retroversion.

It consisted of a gilt pear-shaped pessary, about one and a half, by three-fourths of an inch in diameter, screwed on a small gilt cylinder, the size of a writing quill, and three and a half inches long. This was the pessary. Now the frame on which the pessary was supported, was a hard silver wire, twelve or thirteen inches in length, bent so as to bring its extremities together, .which were secured with hard solder. The wire ring thus made was reduced to the form of an open parallelogram, the angles being left rounded, and a cross piece of silver being adjusted across the middle of the wires, constituted a bed into which the free extremity of the pessary stem was screwed. The flat bar was three-fourths of an inch long, by one-fourth in width. The wire frame was bent so as to make it fit the curve of the inferior part of the trunk of the body; more or less, according to the embonpoint of the patient. A girdle of suspender-web was fastened round the hips just below the crista of the ileum, and straps of leather attached to each extremity of the wire frame, were fastened by the hook and eye to the girdle.

Such an apparatus can be worn with little inconvenience, after a day or two of habituation; and the vagina can be extended, carrying the uterus before it to any desirable length. Patients who have employed it, have been relieved of uterine deviations that would not yield to the globe, the discus, or any other treatment. The greatest objection to this instrument is its costliness, for Mr. John Rorer, of North Sixth street, who has prepared several at my request, informs me they cannot be sold at a price under fifteen dollars each.

There is another pessary in use here, fashioned somewhat like a horse-shoe, either furnished with the corks, that is, by bending the heel of the shoe, or without the corks; I have never used this instrument, nor shall I employ it, since I cannot deem it safe to allow the points of the horse-shoe to be the points of resistance to the whole tenesmic or bearing down power. Such a point of

pressure is too small. Indentation is followed by absorption; upon the same principle as that which causes what is called the bedsore; and ulceration of the compressed points gives insufferable pain.

Having now said all that it is obvious for me in this letter to 'say on the subject of simple prolapsus, and the use of pessaries, and their kinds, I shall proceed now to recapitulate my views on the disorder

1. Prolapsus uteri is a disease of the vagina, not of the womb.

2. To cure prolapsus uteri, you are to seek to cure the vagina, and when you have done that, the womb will be found cured also.

3. The pessary is a suspensory, which in the cure of prolapsus, is as necessary as a suspensory is for an orchitis.

4. I prefer, as a general proposition, the globe, to all other forms, and Dr. Physick's globe pessary to any other.

5. If you apply the pessary in cases not suitable, you will do mischief. There ought to be no inflammation nor ulceration either of the vagina or the womb.

But I defer to my next, some further remarks on the use of the pessary.

C. D. M.

LETTER XV.

PROLAPSUS UTERI.

THERE are certain other circumstances connected with prolapsus uteri, that I ought to notice, as supplementary to the observations contained in my last letter.

The question arises as to the treatment of prolapsus in the unmarried female, and I may observe, that I have been many times asked by my friends of the profession here, whether I had met with prolapsus in young unmarried women, and if so, how I had proceeded in the treatment of them.