The diseases of women : a handbook for students and practitioners . estrictedby the introduction of operative measures; but operationsare in some cases contraindicated by the age or ill-healthof the patient or by her unwillingness to submit to them,whilst in other cases they fail to relieve the condition forwhich they are undertaken. Pessaries remain, therefore,indispensable, though they should be used as seldom aspossible. To be effectual, a pessary must answer the followingrequirements: 1. It must maintain the normal position of the uterus andvaginal walls, and relieve symptoms. 2. When it i
The diseases of women : a handbook for students and practitioners . estrictedby the introduction of operative measures; but operationsare in some cases contraindicated by the age or ill-healthof the patient or by her unwillingness to submit to them,whilst in other cases they fail to relieve the condition forwhich they are undertaken. Pessaries remain, therefore,indispensable, though they should be used as seldom aspossible. To be effectual, a pessary must answer the followingrequirements: 1. It must maintain the normal position of the uterus andvaginal walls, and relieve symptoms. 2. When it is in its place the patient should be uncon-scious of its presence. 3. It must be light, smooth, not acted upon by theuterine and vaginal secretions, and not irritating to thevaginal walls. The best materials for this purpose are alu-minum, vulcanite, block tin, celluloid, and hardened india-rubber. The last three have the advantage that they canbe moulded to any required form ; in the case of celluloidand india-rubber this is done by immersing them in boiling 147. I48 DISEASES OF WOMEN. water, when they become soft, regaining their rigidity oncooling. There are three types of pessary in general use. The Ring Pessary (Fig. 41).—This should be madeof good hard rubber, with a central wire spring, so that it may be compressed to facilitateintroduction and may regain itsshape when released. It is used for cystocele, rec-tocele, and uterine prolapse—i. e. for hernia of the pelvic should not touch the bonyparts of the pelvis, but shouldslightly stretch the lateral vaginalwalls. It depends for its efficacyFig. 4z.—The ring pessary. on the integrity of the posterior vaginal wall and the levator ani,and is useless when the perineum is much lacerated; forthen it comes out as soon as the patient strains, as duringcoughing, sneezing, and defecation. The same result fol-lows if the ring be too small, whilst if too large it interfereswith the action of the bladder and rectum an
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