LECTURES ON THE DISEASES OF WOMEN AND CHILDREN

1829 The Lancet  
Of the Pessary. By pessaries, Gentlemen, you are to understand certain instruments which are introduced into the vagina, with a view of supporting the uterus, the bladder, the vagina itself, and the parts adjacent; and of these instruments there are various forms and i . contrivances. Of the different kinds of pes-' , saries which have been commended to use, the principal consist of the ring pessary, the ball, the sponge, and the pessary which is mounted upon a stem. Ring Pessary.—The ring
more » ... sary.—The ring pessary, on which I shall first make a few remarks, consists of a circular plane of various material-silver, ivory, caoutchouc, or box-wood, for example; thick at the edges, thinner toward the centre, and containing a central aperture, being large enough to admit the point of the fore-finger; not larger, lest the uterus should force itself through the opening, and, in that way, become strangulated. Of these pessaries the accoucheur is to be provided with a succession, consisting of different sizes, rising above each other in diameter; and when he is about to introduce the instrument, he first makes a careful examination of the vagina, to which there can be no objection, as it is necessary for him to interfere manually with the part, in order to introduce the instrument. Having effected this, lie places by the bed-side some three or four of the pessaries, which appear, on comparison, to be best fitted to the vagina; and of these he selects one, lubricates it abundantly, places the woman either in the recumbent posture, or else, which is perhaps, on the whole, fully as convenient, (and more agreeable it may be to female delicacy,) he advises her to take position upon the left side, in the usual obstetric posture. These preliminaries arranged, he lays hold of the pessary, and planting it in the pudendal entrance, with a sort of rotatory motion, he rolls it upwards and backwards along the surface of the sacrum towards the promontory of this bone, with as little force and compression as may be ; the plane of the instrument, at this time, lying parallel with the sides of the pelvis; and then, when he has reached the upper part of the vagina, lie places the plane in apposition with the mouth of the uterus, which then rests upon it as on a shelf, and thus obtains an effectual support. These instruments, however, are very apt to tuto. edge-ways. If the pessary be too large, it can easily be removed at the pleasure of the patient, and a small pessary is easily replaced, when necessary, by one of larger diameter. When you pass up the pessary, you ought to tell your patient that the iirst size will not, perhaps, prove of fit measure for the vagina, and therefore she must not be disappointed, should a change become ;' necessary. To remove the pessary is ex-, ceedingly easy ; you pass the finger into the . vagina, lay it in the central aperture of the pessary, and then roll it downward, careful , that you do not injure the vaginal orifice. The great nicety of introduction consists in i carrying it upwards and backwards, and not t against the point of the pubic arch. 1 have said you are to carry it upwards and back-1 vvards towards the promontory of the sat crum ; because, if you carry it directly up. ; wards, you will occasion a great deal of pain, and, at the same time, the instrument cannot be introduced, as it must fall into collision with the symphysis pubis. In all women, the ring pessary may be employed ; ; 3it is an excellent form of pessary for general use, but for married women it is more espee ciallv accommodated, as it does not mate. n rially obstruct the vagina.
doi:10.1016/s0140-6736(02)91605-3 fatcat:yl3uzeqz6ff2pji4voj6gql5u4