3. Vaginal injections of lukewarm water, either plain or containing antiseptic agents, must be used twice daily, so as to prevent stagnation of the catarrhal secretion which the presence of the foreign body will always occasion.
4. A soft rubber ring should never be worn longer than eight weeks; and one of hard rubber should be removed and cleansed at least once irt that period of time, though it may he worn much longer.
I know of but a single case in which a pessary was worn continuously for years without any evil consequences ensuing, though the patient did not trouble herself about it at all. I was asked to remove it for a trouble in no way connected with that of the womb, and was told to replace it again. I removed with difficulty, on account of its size, a yellow ball of wax as big as a large orange with the help of a polypus forceps. It had exerted a moderate and even tension upon the vaginal walls; and, from its smooth surface and indifferent nature, as well as from the complet,e exclusion of air from the vagina which it ensured, there was so little irritation that although the portio vag. was softened and injected, there was neither erosion nor any other tension.' The case led me to re mark in 1879, in the 1st edition of this work: " The hard rubber balls which Bozemann uses for the preparatory dilatation of the cicatricial vagina, before operating for vesico-vaginal fistula, seem t,o rank next to those of wax in respect to the small amount of irritation they occasion. My experience with them is as dilators, not as pessaries; but I think they might well be occasionally used as such." Of late years I have made great use of the so-called egg pesasries for the palliative retention of vaginal and uterine prolapsus, especially when they are of long standing, and in women who have passed the climacterium.' 'They consist of light hollow pessaries of bard rubber, of various sizes and egg.shaped.
The even and moderate tension of the vaginal walls which they occa sion, the stability with which they maintain their position over the mus cular pelvic floor, the exclusion of air, combined with their smooth surface and indifferent material, render these pessaries the most desirable of all, and the ones which entail in the least degree the evil consequences due to the presence of a foreign body.
For their removal I use a small pair of forceps made especially for the purpose, if they are so firmly seated that they cannot be expressed by ab dominal tension. I would refer the reader for fuller particulars in regard to these pessaries to the communication referred to above, and will only state here that I have several times had occasion to use them in women who were still menstruating, and have had abundant proof that they in no way interfere with that process. Nevertheless this form of pessary puts a stop to sexual intercourse, and it is applicable especially to women at the ages at which involntion of the sexual organs has occurred.
When there is not sufficient support for pessaries, bandages may be used. They should press upon and irritate the parts as little as possible, should not interfere with the motions of the body, and should be readily introduced and easily cleansed. And withal they must not be too expensive; for not only must they be within the means of the working classes, but the intra-vaginal part, at least, must be frequently changed..
I will not describe these appliances in detail, since that will be done under the heading of prolapsus uteri. I will only say that I myself employ a simple T-bandage with elastic insertion, to the middle piece of which a smooth, hard, rubber, pear-shaped pessary is attached by moans of a stout gutta-percha stalk." '