Treatise on gynæcology : medical and surgical . be continued. The accidents which havebeen described as the effect of forgotten pessaries are due to their com-plete neglect for years, with no attempt toward cleanliness. [The Albert Smith type of pessary, both with and without the 448 CLINICAL AJSTD OPERATIVE GYNAECOLOGY. thickened posterior bar, is the most generally useful, and it is seldomthat any other form will be required in the treatment of retro-displace-ments. This is employed with a posterior bar having a gentle sweepin simple retroversion, and with a more pronounced curve, up to 90°,
Treatise on gynæcology : medical and surgical . be continued. The accidents which havebeen described as the effect of forgotten pessaries are due to their com-plete neglect for years, with no attempt toward cleanliness. [The Albert Smith type of pessary, both with and without the 448 CLINICAL AJSTD OPERATIVE GYNAECOLOGY. thickened posterior bar, is the most generally useful, and it is seldomthat any other form will be required in the treatment of retro-displace-ments. This is employed with a posterior bar having a gentle sweepin simple retroversion, and with a more pronounced curve, up to 90°,when a flexion is to be overcome. It is to be remembered that this pessary does not act by a generalover-distention of the vagina, but by pushing up the posterior cul-de-sac and thus drawing the cervix backward and upward. When prop-erly fitted, it should cause no pain, should not project from the vaginaor be felt by the patient, should be movable and small enough so thatthe finger can be swept between it and the vagina at every accessible L. Fig. 240.—Munde-Thomas Pessary in Place after Reduction op a Retrodeviation. point without tension. It should never be introduced until the uterushas been replaced, never when there is any marked tenderness or in-flammation present in any part of the pelvis. The patient must alwaysbe told that she is wearing a pessary, and that she must remove it byhooking her finger over the anterior bar and pulling downward if itcauses pain at any time. She must keep the parts clean by a dailycleansing warm injection, with a little soda bicarbonate added. In-jections of alum or any sulphate are to be avoided, as they soon causethe pessary to become roughened by incrustations. The pessaryshould be removed at least once in three months, to be cleaned andpolished. So far, no better material has been found than polished hard-rubber of good quality. While it is truly said that very few perma-nent cures result from the use of these instruments, they are mo
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