INTRAUTERINE PESSARIES.
Aetius and Galenus were in the habit of treating displacements of the uterus by means of the finger and of the sound, but the steps of their method are not known to us. Winckel says that Moller, in 1803, was the first to raise up and hold the flexed uterus straight by means of a force acting within the organ. He used for this purpose an elastic cathe ter or tube, through which a differently curved wire was passed, a proce dure which has latterly been readvocated by Hertzka.
It would seem as if Amussat, in the year 1826, was the first to prac tice the insertion of a stem into the uterus in order to straighten out a flexion and to maintain the organ in the desired shape. It was not until twenty years thereafter that the intra-uterine orthopedic treatment re ceived recognition, when Simpson, Valleii and Kiwisch, at about the same time, presented their instruments and reported the results they had obtained from their use.
It is seldom that there has been so much discussion in regard to the worth of a therapeutic method as there has in connection with the use of the intra-uterine stem. Since the first expression of opinion at the Paris Academy of Medicine, in 1854, gynecologists have been divided into two parties, and even to-day there is no unanimity of opinion, some highly praising the stem, others absolutely rejecting it; indeed in one and the same case two distinguished authorities have claimed that the opposite views were each proved. (Winckel, Spiegelberg.) Between the parti sans of the stem (Amussat, Simpson, Lee, Valleix, Gaussail, Velpeau, Kiwisch, C. Mayer, Detschy, E. Martin, Veit, Olshausen, Hildebrandt, Haartmann, Winckel, Schroder, M. Sims, Hennig, Kristeller, Graily Hewitt, Priestley, Savage, Greenhalgh, Beatty, Courty, Weber, Amann, Grenser, Benicke, Beigel, Bantock, Chambers, Rigby, Atthill, Routh, Korner, Goodell, A. Martin, Coghill, etc.), and the opponents (Depaul, Raciboreky, Piorry, Gibert, Amussat (later), Cazeaux, Scanzoni, Hueter, Hohl, C. Braun, Seyfert, Crede, Freund, Spiegelberg, Spiith, Habit, Retzius, Tilt, Meadows, Oldham, Benett, West, M. Duncan, Tani, Peas lee, etc.), there is a mean group (Schultze, Hegar and Kaltenbach, G.
Braun, Thomas, Frankenhitiuser, Fritsch and others), who do not fully reject the stem, but only very exceptionally use it at all, even as was claimed for the instrument by Robert and Huguier during the discussion before the Paris Academy.
It is but fair that I should state my own impression in regard to this controversy. In 1870 I reported a case of cure of retrofiexion of the uterus, accompanied by respiratory neurosis, by means of the intra uterine stem, and since that time I have been unable to entirely reject the stem, but have used it in a number of instances of flexion, amenor rhea, torpor of the uterus. Except in the first case I have uniformly used the simple stem, very rarely the one attached to a Hodge or a Schultze figure of eight. In about 8000 cases I have used the stem fully as often as forty times. Only in the first case, whore the ultimate result was a complete success, did there develop a parametritis; in all the others there were symptoms of irritability, such as profuse discharge, hemor rhage. I have never been able to note a permanent cure except in the first case, although there was relief of the dysmenorrhea, amenorrhea, and a cessation of the migraine, and other symptoms—a cessation, how ever, which generally only lasted while the stem was worn. Last year I again had the opportunity of seeing the good effect of an intra-uterine stem, inserted in a case of flexion, on a bronchial asthma which disap peared during the wearing of the stem, only to reappear on its removal. All other method of treatment had failed.
Since, in the small number of instances in which I have tested the stem, I have not obtained better results than in those treated without it, I have more and more limited the cases in which I deem it useful, al though when carefully watched I do not consider it a specially dangerous instrument. I believe it to be an agent for use only in those instances where other means have been tried without avail, and where the severity of the symptoms justifies resort to a method which is not entirely free from danger.