. The diagnosis and treatment of diseases of women. losely attached) and also bypushing upward and backward onthe sacro-uterine ligaments, thusputting them on the stretch. To ac-complish this, the anterior portion [of the pessary must have a ratherfirm support, which it gets fromthe pubic arch (with intervening ,, ^ soft tissues) and the pelvic floor. tC The action of the pessary, with ^its many curves, seems to be a veri-table puzzle to many students andto not a few practitioners, yet it is Vclear enough when properly ap-proached and studied. In order to ^make the matter clear to my classesin
. The diagnosis and treatment of diseases of women. losely attached) and also bypushing upward and backward onthe sacro-uterine ligaments, thusputting them on the stretch. To ac-complish this, the anterior portion [of the pessary must have a ratherfirm support, which it gets fromthe pubic arch (with intervening ,, ^ soft tissues) and the pelvic floor. tC The action of the pessary, with ^its many curves, seems to be a veri-table puzzle to many students andto not a few practitioners, yet it is Vclear enough when properly ap-proached and studied. In order to ^make the matter clear to my classesin a short explanation, I am accus-tomed to approach the subject syn-thetically so to speak, i, e., to grad- ~ — -^ .4 Ually build up in mind such a pes- pi^. 453. The Pessary in Place. The action of the Sary. We know that after a mOV- pessary is to hold the posterior vaginal fornix, and with „1^1„ „„i ]• 1 1 J. T 1 it the attached cervix, well backward and upward in able retrodisplaced uterus has been .^e pelvis, ^^eu^mseases of women.). 330 GYNECOLOGIC TREATMENT replaced, if we keep the cervix well back in the pelvic cavity, that is, a certaindistance from the vaginal outlet, the fundus will stay forward (Fig. 453). Sup-pose then that we introduce a straight stick that reaches from the public arch tothe posterior vaginal vault. Now as long as the anterior end of the stick is sup-ported by the pubic arch, neither the posterior vaginal fornix nor the cervix,which is closely attached to it, can approach the vaginal outlet. The cervix canmove up and down through a small arc, but it can not come any nearer thevaginal outlet and consequently as the cervix is held well back in the pelvis thefundus uteri stays forward. This is practically the action of the pessary. It takes its fixed point of supportfrom the pubic arch (the soft tissues intervening), being held up against the narrowpart of the arch by the pelvic floor. As long as the anterior end of the pessary isproperly s
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