The diagnosis, anteflexion of the uterus, seemed unquestionable. But I was sure that some other means of treatment must be resorted to than had already been made use of. After some experimenting, I contrived a very simple modification of the ring pessary of Professor Hodge. This modification consists in springing an arch across the anterior third of the ring of such a height and at such an angle as the case in hand demands. This arch can be put upon a common ring by any one who has a very moderate degree of mechanical skill. All that is necessary, is a ring of suitable size and a sufficient arc of another ring welded to it by means of an alcohol lamp. The instrument is very readily put in situ with the arch going up just posteriorly to the arch of the pubis. The fundus of the uterus rides upon this arch and must be upheld by it. There is no danger of ulceration and there is no danger of injury to the lining membrane of the uterus. Pressure is at once removed from the bladder if the instrument is properly adapted to the case. In the case alluded to above, the patient went to her home after a few weeks entirely relieved from all bad symptoms. I heard from her one year after treatment. She was then teaching in a large female seminary--had ceased altogether to have painful or too frequent menstruation. Micturition was perfectly normal. She called herself well, and as a proof of it she sent word to me that she had that day skated three miles. Since January, 1863, I have treated nearly a dozen cases of anteflexion and anteversion of the uterus with this pessary, and in no one of them have I been disappointed in its efficiency. I take pleasure, therefore, in presenting a photograph of the instrument to this Association. It is simple in its construction, is adapted to the end to be accomplished, and can be always at the command of any one. KALAMAZOO, MICH., May 15th, 1864. ON THE USE OF PESSARIES. AMONG the whole catalogue of the diseases peculiar to women there are none supposed to be so prevalent as falling and displacements generally of the womb, and there are none of so little real importance as these. In fact it may almost be said that no such diseases exist, this condition being usually, in the vast majority of cases, only a symptom of some other affection. Still, in the same manner as we hear physicians, of more or less erudition, talking of patients sick with dropsy, and giving burial-certificates for death by dropsy, we hear the same class of physicians having patients with falling of the womb, and inventing instruments and more or less barbarous machines of torture for the cure of falling of the womb and other displacements. Now I will not positively assert that there is no such thing as simple falling of the womb, but it is no more frequent, I believe, than idiopathic dropsy; so rare, indeed, that I cannot remember having seen it of late years, and I doubt if the cases which I formerly supposed to be such, would stand an examination in the light of the present knowledge upon the subject. If, then, what has been called prolapsus uteri-to consider this alone-is but a symptom of some other disease, it is manifestly absurd to direct curative measures to the symptom, although palliative measures might be admissible, and therefore it follows, that the treatment of falling of the womb, prolapsus uteri, procidentia uteri, chute de l'uterus by pessaries, unless used as palliative applications, is necessarily absurd, illogical in idea, necessarily unproductive of good; and, as a non sequitur, is productive of injury, and savors too much of charlatanry and a desire to transfer the contents of the pockets of the patient into those of the physician. To commence this subject afresh. Falling of the womb, in its various forms and varieties, which it is not necessary in this paper to enumerate, is the displacement of the womb downwards, to a greater or less extent. It is a symptom of some other disturbance, upon which it depends. It has formerly been considered to be caused not unfrequently by a relaxation and consequent elongation of the ligaments which normally act as stays and braces to it. In the great majority of cases, however, where many of the symptoms of falling of the womb are present, this organ has not changed its position sufficiently to make any great traction upon the ligaments, and although the womb has settled somewhat, the ligaments are not materially lengthened, even if their direction is changed and their angle with the uterus is made more oblique. This evinces that the uterus is held in position by some other, at least additional means, and this we find to be the vagina, in its turn supported by the perineum. A destruction or relaxation of one or both of these portions removes the base upon which the uterus rests. It may also be mentioned, en passant, that the symptoms of weight and dragging in the groins are sometimes found where there is no observable displacement of the organ, and again these symptoms are entirely wanting where the uterus has descended so as to be actually observable when the patient is standing erect, evidently showing that the symptoms are erroneously ascribed to the existence of displacement. We are therefore compelled to look for some other cause both for the displacement which exists and for the painful symptoms that accompany it; and this we find in the condition of the uterus itself. Bennet first alluded to the fact of the hypertrophic condition of the neck of the uterus as the cause, erroneously ascribing to this condition the displacement in every instance, overlooking the cases of general hypertrophy of the entire organ which are often the cause. We find it also not unfrequently in the early months of pregnancy. In fact it almost always exists normally, until the uterus is so large that it can rest upon the pubis and the ischia, but owing to the fact of the absence of any disease there is no disturbance caused thereby, and this fact is worthy of notice, as it shows that the symptom of prolapsus is unimportant, and that it is the ulceration, inflammation, or the attending and causative disease which is the source of irritation and the creator of the local and general disturbance. It follows, therefore, without any argument to the regular professional man, that the treatment shall be directed to the cause, and if owing to the increased weight of the entire organ, or of the neck only, the aim should be to restore it to its normal condition, and according to the cause, in individual cases, should the treatment be directed. If there be thickening from chronic inflammation, intra |