Minor surgical gynecology : a manual of uterine diagnosis and the lesser technicalities of gynecological practice : for the use of the advanced student and general practitioner . osits, and the more irritating will it become. Cases have been observedin which a Zwanck perforated the bladder, and instances of injury of therectum, and of Douglas pouch have been reported. These accidents weremostly produced by the clumsy old pessaries, which were wanting in allmechanical principle and acted only by their bulk. But cases of ulcera-tion of the vaginal wall from Thomas cup, Hodges and Smiths leverpes
Minor surgical gynecology : a manual of uterine diagnosis and the lesser technicalities of gynecological practice : for the use of the advanced student and general practitioner . osits, and the more irritating will it become. Cases have been observedin which a Zwanck perforated the bladder, and instances of injury of therectum, and of Douglas pouch have been reported. These accidents weremostly produced by the clumsy old pessaries, which were wanting in allmechanical principle and acted only by their bulk. But cases of ulcera-tion of the vaginal wall from Thomas cup, Hodges and Smiths leverpessary, are occasionally met with. I have seen one instance of a local-ized cellulitis near the left descending ramus of the pubic arch from a toolarge Hodge, and one case in which one of the hinges of a well-fittingThomas cup pessary, which had been left in the vagina for five months, con-trary to particular directions, had perforated the rectal wall. _ The minutefistula only admitted a fine anatomical probe, and healed without treat-ment in a week after removal of the pessary. With due attention to aproper choice of pessary, to cleanliness and with occasional supervision,. 356 A TREATISE ON MINOR SURGICAL GYNECOLOGY. such accidents should not and will but rarely occur. Worse results arenot reported to have followed, except one case of myelitis supposed tohave followed a pessary, cited by Verneuil; and Hegar and Ohrobak eachnoticed cancerous infiltration at a spot where the pressure of a pessary hadproduced granulations. Such cases are certainly rare exceptions, and can-not weigh as counter-indications to the use of pessaries. The curative results from pessaries are not as encouraging as we couldwish them to be. If applied at an early stage of the displacement, and espe-cially at a time when the natural involution of the pelvic organs—uterus,ligaments, and cellular tissue—favors a restitutio ad integrum, pessariesmay, after a certain time, several months or more, produce an
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