CONTRIBUTIONS 
TO 
PRACTICAL GYNAECOLOGY. 
DONALDSON. CONTRIBUTIONS TO PRACTICAL GYNECOLOGY.* 
ILLUSTRATED WITH SIXTEEN WOOD ENGRAVINGS. 
By S. JAMES DONALDSON, M.D., 
Fellow of the New York Medico-Chirurgtcal Society, Surgeon to Gynaecological Wards, Ward \s Island Hospital. 
PART I.—Practical Observations Upon Uterine Deflexions. 
PART II.—Practical Observations Upon Dysmenorrhoea. 
Read before the New York Medico-Chirurgical Society 
We have before us an interesting work of one hundred 
and thirty-six octavo pages, with the above title. The text 
is bold and vigorous in style, and evidently the work of 
much careful study. While departing somewhat from 
stereotyped views as to the etiology and mechanical treat- 
ment of uterine displacements, the author manifestly 
holds the most practical opinions regarding the subject 
of which he treats. 
Dr. Donaldson begins his discussion by a considera- 
tion of the growth and present standing of gynaecology. 
He questions if there lias been such remarkable pro- 
gress made as is generally believed, in the ordinary 
anomalies, such as dislocations, dysmenorrhoea, and kin- 
dred affections. He is inclined to the opinion that more 
harm than benefit has resulted from the treatment of 
these abnormities by unskillful manipulation and ill- 
constructed appliances, as well as the innate tendency 
of the majority to run tandem after certain leaders, fol- 
lowing stereotyped'ideas instead of adhering more closely 
to the common sense views always to be found in the 
teachings of nature. He maintains that for years we 
have been attempting to accomplish results which the 
use of the absurd instruments usually adopted has al- 
most invariably defeated, and says : 
“ The parties who are really culpable in this matter are the 
teachers who, through ignorance or indifference, have inculcated 
erroneous ideas by incorrect assertions or through the use of ridic- 
ulous diagrams. These have done more to embarrass and perplex 
the after lives of students than can be expressed. Better far that 
intelligent minds be left free to practice in accordance with the sug- 
gestions of independent reason, than be compelled to spend vears 
in perplexity trying to unlearn these college-received fallacies. 
Look, for example, at any of the numerous absurdities that disgrace 
our most popular text-books. In many of these diagrams it would 
appear that the design was to adapt the pelvic organs to the confor- 
mation of some instrument, and to display its mode of adjustment, 
which by the illustration is made to look quite feasible; but when 
we put it to the actual test, we soon learn how completely we 
have been misguided and discover its entire impracticability. If 
we found these caricatures in some ancient medical work, we 
would pity the ignorance of the past; but to encounter them re- 
peatedly in our most modern standard works, is an annoyance most 
diAAcult to tolerate. 
Then follows a number of familiar diagrams copied 
from the text books, and usually employed by them 
when dealing with the subject of the female pelvis, 
and their misrepresentations, as well as peculiarities, 
criticised. 
We agree with Dr. Donaldson that the illustrations 
should harmonize with the text, and that many of the 
text book diagrams are “pictorial stumbling blocks.” 
This part of the discussion he closes with a sketch of 
the female pelvis and trunk. 
“ We take for our Axed point the pubic bone, and measure, at an 
angle of slxty-two degrees with the horizon, four and one-fourth 
inches, and there Ax the sacral prominence. Next we measure 
J. H. VAIL & CO., 21 Astor Place, N. Y. 
! from the centre of the pubic bone, at an angle of forty degrees, four 
and one-half Inches, and fix the hollow of the sacrum. From the in- 
ferior border of the pubic bone, at an angle of twelve degrees, we 
measure four and a half inches, and place tne point of the coccyx. 
Guided by these points, we represent the sacral, coccygeal, and pubic 
bones. We have now the frame work of the pelvic walls. After outlin- 
ing the trunk walls with proper curves, we proceed to place the pelvic 
organs. We make the measurements of the vaginal walls—anteri- 
orly three inches, posteriorly four inches, as an average—ana fix 
the entrance to the vagina three-fourths of an inch below the pubic 
bone. Now come reminiscences of our early speculum and pessary 
experiences. Fresh from college training, we possessed the stereo- 
typed ideas, and expected to And a vagina following the pelvic 
; curve, leading into the abdominal cavity, with the os uteri looking 
I directly into the tube. How great was our perplexity to find the va- 
I gina dipping backward toward the hollow of the sacrum, with the 
uterus at right angles. What strenuous efforts we made to induce 
our pessaries to occupy what we then regarded as their proper 
place! But strive as we might, they persisted in lying in the axis 
of the vagina, which pointed directly into the hollow of the sacrum, 
while the poor uterus, as if conscious of the mischief which had be- 
fallen it, seemed striving to evade our inspection. Anteversions 
were rife in those days, and we blush to contemplate the curious in- 
struments left upon our hands, with which we then strove to prop up 
the uterus and teach it a new position. Fortunately for our patients, 
we became discouraged with our useless efforts, and desisted, when, 
much to our chagrin, the sufferers usually improved. So we began 
to question if it might not be ourselves who were at fault instead of 
the much abused uterus. 
“ From careful anatomical observation, we And that the uterus 
naturally looks backward and downward to the second coccygeal 
bone. At right angles with it the vaginal axis points into the hol- 
| low of the sacrum, in the direction of the third sacral bone. Keep- 
ing these facts in mind we proceed in our delineation, and draught 
the uterus and vagina with proportionate dimensions, and And we 
have the uterus safely ensconced beneath the overhanging arch of 
the sacrum. After representing the bladder and soft structures, we 
next deAne the axis of the body. This imaginary line, A A, in a 
properly poised body, extends from the vertex, through the trunk, 
touching the anterior surface of the second lumbar vertebra and the 
| inferior border of the pubic bone downward to the point between 
the plantar arches. Having drawn a line, B B, at an angle of sixty- 
two degrees, to represent the plane of the pelvis, we draw another, 
C C, to represent the pelvic axis. And now the beautiful mechanism 
of the female pelvis reveals itself. Notice how these lines intersect 
i each other at a deAnite point. Observe the home of the uterus 
j bounded by these lines and sheltered by the protecting arch of the 
I sacrum, while, in the angle below, the bladder, admirably situated, 
l acts as a grateful cushion. Look also at the graceful, receding 
curve of the dorsal wall; conceive how an impulse, glancing down 
this incline, must be projected downward and forward to expend its 
force upon the resilient concave abdominal walls, while the reAex 
current will move in such a direction as to really lift the pear- 
shaped uterine body toward the arch. Consider the position of the 
os pubis, how it is the centre of gravitation for the abdominal vis- 
cera, while not an ounce of weight is allowed to rest upon the 
womb.” 
Concerning the etiology and treatment of displace- 
ments, the author attaches great importance to the 
posture of the body, and states that: 
“ A Armly poised body is a necessity to the maintenance of that 
harmonious antagonism of all the muscular support and balance of 
the various members of the body. But where one part of the active 
Abre is unduly tense, with a corresponding portion lax, we need not 
expect to tindthe organs sustaining their normal position. More- 
I over, with a truncal deviation the resistant structures, such as the 
' pubic bone and sacral prominence, are diverged from their full and 
[*A Review. Reprinted from the New York Medical Times for August, 1882.] 3 
proper functions, and no longer afford sufficient support and protec- 
tion. With the shoulders advanced and the dorsal region retracted 
the body loses its graceful contour by the straightening of its curves, 
and the truncal tube becomes, to a certain degree, straightened. 
The centre of the visceral gravitation is no longer through the pow- 
erful pubic bone, but through the pelvic curve; consequently every 
importance of exercise as influencing- the condition of the 
female generative organs, after the following manner : 
“ We are aware that the body is composed almost entirely of cap- 
illaries, and upon capillary tonicity depends the health of the body; 
for instance, inflammation is simply an increased determination of 
arterial blood to a part whose capillaries have lost their contracts 
power and become dilated, while passive congestion is simply an ex- 
pression of relaxed vital resistance of the capillary walls. Now the 
lack of exercise produces this degenerate, dilated condition of the 
capillaries, thereby creating general blood-stasis, which is a form of 
death. By exercise we secure the constringing of these minute 
blood-carriers through the stimulus of alternate contraction and re- 
laxation of the muscles. Some pathologists maintain that there is but 
one essential proximate cause of disease, viz., the loss of vital resis- 
tance and the enlargement of the capillary vessels. The indication 
then would be, that the cure of disease must necessarily be preceded 
by the constringing of the capillaries and a restoration of their con- 
tractile power.” 
Forcible defecation is also cited as one of the chief 
factors in producing prolapsus, regarding the treatment 
of which he makes these pertinent observations : 
“ It is safe to state that there is no disease more readily cured or 
more universally maltreated, than constipation. Physicians, as 
well as laymen, from time immemorial, have run foolishly after 
cathartics. They have seemed possessed with the idea that the 
disease lay materialized somewhere along the alimentary canal, 
w'aiting to be dislodged by some brisk purgative. So firmly estab- 
lished is this pernicious practice that it is combated at the risk of 
losing caste. The child no sooner breathes than it must swallow a 
portion pf physic, and from that moment until the hour of death the 
intestinal tract must be tortured by the use of drugs. It is by this 
injurious practice that constipation is greatly augmented, for I chal- 
lenge the world to produce a single cathartic drug, given in small 
or large quantities, which will not, by its secondary effect, induce 
constipation. Laxatives are our sheet-anchor in diarrhoeas, but in 
the opposite condition they only enhance the difficulty; indeed, 
costiveness can be created at will by an occasional administering 
of a purgative.” 
After a due consideration of practical hygienic laws, 
the subject of mechanical appliances is next taken up, 
concerning which Dr. Donaldson remarks : 
“The ingenuity of medical men has been exhausted in the search for 
some effective invention. So earnest and active has been the labor 
in this matter that, judging from the numerous strange productions, 
we feel persuaded that not a few have gone daft on the subject, for 
surely none but men of distorted imaginations could invent and 
recommend such twisted absurdities as we find in the catalogue of 
pessaries. Place before an intelligent layman the heaps of abomi- 
nations which have been invented, advocated and adopted for suf- 
fering women, and after examining one by one the unseemly, con- 
trivances, of every conceivable shape and material, imagine his 
confusion as to what manner of organ the vagina might be. The 
probable design of many of these inventions would perplex even an 
anatomist. Now then, there is no reason why the vagina (simply 
because it is elastic and will accommodate itself to any shape or 
size, from a pledget of cotton to a child’s head) should be converted 
into a curiosity shop. These vile contrivances are a disgrace and 
dark stain upon the history of gynaecology, and we hope the most 
of them will soon receive their merited condemnation, and will only 
be found in their proper place—in the chamber of horrors.” 
Dr. Donaldson regards prolapsus as simply a disinte- 
gration of the vaginal walls, which permits the uterine 
cervix to advance from its position underneath the 
sacral arch. Its cure, therefore, consists in restoring 
these weakened walls to their original length in as non- 
irritating a manner as possible. His idea of a properly 
constructed pessary is given as follows : 
“ Every foreign body acts more or less as an irritant, and there- 
fore should be no larger than is absolutely required, and should be 
so constructed, whenever feasible, as to be under the control of the 
patient, who should be instructed regarding its removal and replac- 
ment, as she should wear it only when actually needed. It is abso- 
lutely necessary that it be so constructed as to allow the vaginal 
walls to sustain their natural relations ; therefore we will make it 
flat, wider above than below, but never so wide as to stretch the 
walls of the vagina, bearing in mind the fact that in a prolapsed 
state the vagina is wider than after reduction. Its length should be 
sufficient to carry the uterine portion of the vagina so far back as to 
cause the os to look toward the saero-coccygeal joint, but it should 
not be so long as to produce any undue traction on this portion of 
the vavina, for by so doing we will defeat our object by producing 
laxity of posterior vaginal wall and may induce areolar hyperplasia 
at its point of pressure. Add to the foregoinsr considerations a cor- 
rect understanding of the vaginal axis, and we possess all the im- 
portant features of a pessary. Viewed in the light of these princi- 
ples, what a harrowing study the vast array of these inventions 
becomes, many of them being a stain upon the good name which 
alone ever secured for them a recognition.” 
He maintains tbat every form of stem-cup pessary is 
faulty, inasmuch as the uterus must he dislocated for- 
ward and retroverted, before the cervix will look into 
Fig. 4.—Diagram showing the normal position of Jhe female generative 
organs and their relations in a correctly poised erect body. 
concussion and pressure from above is received through the soft and 
yielding pelvic tissues, and these gradually yield under the superim- 
posed influences until dislocations and prolapsus become established. 
It must be understood, when we speak of the erect position, we in- 
clude the sitting as well as the standing posture. Assuming an in- 
correct poise while sitting is a more universal habit, and demands 
more attention than any other, from the fact that so much more 
time is spent in sitting than standing.” 
After criticising tlie positions usually assumed, and 
condemning the faulty construction of the modern chair, 
for producing much mischief, the horizontal position is 
considered and reasons given why the semi-prone posi- 
tion should be observed. He discusses at length the 4 
the cup ; while if this style of pessary is introduced, 
with the uterus in its normal position, the edge of the 
cup is impinged against the anterior surface of the 
cervix uteri. All forms of vaginal appliances for ante- 
flexion and anteversion he dismisses as unworthy of 
consideration. 
The following is a description of the author’s pessary, 
with a design illustrating its mode of application : 
A copper wire loop bent so as to conform to the vaginal curves, 
and its approximated ends bent to conform with the perineal angle; 
this wire loop is covered with soft rubber, which is continuous with 
a tube of the same material, thereby securing smoothness and 
softness at the point of exit from the body, a seat of great annoy- 
ance with the use of the hard material, this being the experience 
of all who have used them. We also do away with the unevenness 
which cannot be avoided where the rubber tube is attached to the 
hard rubber loop, another important feature. The rubber tube 
we construct quite light, so as to avoid unneccessary traction 
upon the instrument. This tube is attached behind to an elastic 
belt surrounding the body (see Fig. 5). The vaginal portion being 
troublesome ulcerations, and frequently the patient is forgotten or 
lost sight of while wearing a pessary, when the instrument may 
burrow itself into the parts, and fistulas and other distressing acci- 
dents occur. From all these ot jections this pessary is free, and it is 
the only pessary with which I am acquainted that combines simplic- 
ity, practicability, comfort, and a promise of final restoration of the 
parts affected. While it is free from the objectionable features of 
other vaginal pessaries, it achieves everything that can be accom- 
plished by any vaginal pessary in every form of prolapsus. 
The subject of flexions is next taken up. 
First on the list come those distortions which are the 
sequelae of versions following degeneration of vaginal 
structures. The os uteri deprived of its normal bearings, 
the uterine body first totters under its own and super- 
imposed weight, and then proceeds to bend upon itself. 
Second, those cases which are the product of inflamma- 
tory processes ; some portion of the uterus or its append- 
ages has been the centre of hyperaemia which has caused 
an exudation of lymph. This circumscribed interstitial 
deposit, becoming organized, welds the tissue fibres to- 
gether, producing fixedness and subsequent contraction 
of the involved textures. In this way the freedom of cir- 
culation and normal movements of the uterus are inter- 
fered with, while the fundus through this local short- 
ening, is induced to gradually bend over the point of 
disturbance. Third, there is a condition of atony, in 
which the uterine walls are flaccid and thin, possessing 
no power of resistance, and bending from sheer flabbi- 
ness. 
The author goes on to explain that the cramped con- 
dition of the uterine body, together with the twisting of 
the broad ligaments upon themselves, prevents normal 
circulation and favors new plastic deposit, and tissue 
degeneration. Therefore, the first object towards cure is 
the straightening of the crooked uterus. He states, “ If 
straightened by the use of the sound, we find that it 
immediately resumes its distortion upon the withdrawal 
of the sound ; any attempt to replace it per vaginam only 
causes it to oscillate as if pivoted at the point of 
flexure. He demonstrates by argument and diagrams, 
that the stereotyped mode of treating flexures by vaginal 
appliances is reprehensible, inasmuch as the foreign 
substance is made to press upon the diseased parts, 
inducing further development of interstitial deposit. He 
claims also that by these appliances, the uterine body is 
not straightened, but merely crowded out of the reach 
of the finger, while it still maintains its bent condition. 
To prove this fact he recommends the introduction of a 
fine probe into the uterus after the pessary is in situ. 
Further on the question is broached. 
“ How, then, can we deal with these chronic flexions? Here we 
have an elastic, hent organ, presenting no possible opportunity of 
being straightened by any external treatment. There is but one 
rational plan to pursue, that is, the introduction of a splint within 
the cavity of the hent uterus, whereby it can be placed in its normal 
position and retained there a sufficient length of time, until Nature 
has, by absorption and new deposit, established the parts in proper 
condition. There are absolutely but two alternatives: Either to de- 
vise and adopt some such mechanical measure, or to abandon the 
patient to her misfortune, fated to a life of progressive wretched- 
ness. For a long time the necessity of an intra-uterine splint has 
been felt by the profession, and its merits and demerits freely dis- 
cussed. Why the stem pessary has so long occupied this debatable 
position is readily explained. Its indispensability has provided its 
own advocates, while the crude and evil-looking instruments pre- 
sented, naturally stimulated an opposition. Surely, the inventors of 
many of these instruments must have had a very imperfect appre- 
ciation of the nature of the highly organized structures under con- 
sideration. Fortunately for all concerned, while the uterus is deli- 
cately organized and is entitled to the gentlest manipulation, it is 
also astonishingly tolerant of rough usage. Those conversant with 
uterine pathology must have been impressed with the oft-witnessed 
freakishness of the uterus. A womb which will resent the intro- 
duction of a sound or even a delicate probe, developing alarming 
symptoms therefrom, will undergo the ordeal of gradual dilation 
and gentle deviation to a remarkable extent without evincing any 
annoyance. Indeed, the uterus is in complete harmony with it's 
whimsical owner. Either is disposed to resent sudden encroach- 
ment and rude shocks, and rebel if undue force is applied ; while by 
gentle measures and gradual approaching tactics, the crotchets of 
either may be avoided. This principle cannot be over-estimated; 
and it demands earnest application in the treatment of these cases, 
if we would avoid discomfiture.” * * * 
“The resume of my experience might be expressed as follows: 
Those stem pessaries that are rigid and have an external support 
connected to a band encircling the body are reprehensible, as they 
necessarily prevent the natural play of the uterus, drag it forward, 
and subject it to injuries from shocks from within and without. 
Fig. 5.—Diagram illustrating Dr. Donaldson’s retroversion and 
prolapsus pessary with the same adjusted. 
of yielding material, is more grateful to the sensitive vaginal tis- 
sues. One of the chief ends to he sought for in a pessary (the 
unconsciousness of the foreign body) is thereby secured. The in- 
strument which constantly directs the mind of the patient to her 
complaint will certainly fail, in proportion to its irritating qualities. 
This pessary, besides being made in three sizes—three, three and a 
half and four inches—is susceptible of modification through the 
adaptability of the copper wire, and can be moulded to fit accu- 
rately the angle of the perineal body. Another recommenda- 
tion is that it can be easily managed by the patient. The instru- 
ment should always be removed at night or while the patient is in 
the recumbent position, and can be removed and inserted as the 
symptoms of the patient will readily suggest, and in this way the 
weakened tissues may be gradually coaxed and trained back to their 
former tone, while the use of the support is gradually discontinued. 
Every physician is well aware of the uselessness of expecting any 
restorative benefits from an internal pessary worn constantly. In 
fact, we know that the atrophy of the vaginal walls is only increased 
by this pressure, just as a splint worn for a long time on a limb pro- 
duces atrophy 
After months and years of continuous wearing of perfect-fitting 
pessaries we" have removed them only to learn that the tendency to 
prolapsus is augmented, while frequently the persistent irritation 
caused by the foreign body develops a chronic hyperplasia of the 
uterus, with disintegration of the cellular tissues; and thus matters 
go on from bad to worse with the patient. Again, it is not an 
unusual occurrence to find that the hard substance produces very 5 
Those appliances which have a solid base, or are firmly connected 
with the vaginal portion, are dangerous, as they preclude the nor- 
mal movements and vibrations of the uterus and bruise the sensitive 
os tincae, while they are wholly Impracticable in the treatment of 
virgins.” 
“ The simple stem with vaginal bulb is unmanageable, as, unsup- 
ported, it will drop out into the vagina, or, when made to press 
against the os by the use of tampons, is liable to work into the cavity 
of the womb, as the os is very prone to dilate and swallow the bulb, 
thereby endangering the fundus, and frequently causing us no little 
embarrassment in the removal. Besides, the daily tamponing of 
the vagina, which this style of instrument necessitates, is an irrita- 
ting, disgusting phase, of which the patient and physician become 
equally weary. The annoying and dangerous complications at- 
tending the use of those (seemingly) indispensable instruments has 
for a long time kept my mind engaged devising some appliance 
whereby these objectionable features might be done away with. 
The results of these researches are embodied in the form of pessary 
which I now present for consideration. Our first requisitions in the 
selection of an intra-uterine splint are non-irritation and safety. 
With this object in view I have selected for the intra-uterine splint a 
silver-plated steel-wire spiral spring, sheathed in elastic material. 
This coil is about two inches in length, with a diameter of one- 
twelfth of an inch, and is screwed into a hard rubber button five- 
proper guidance in balancing the uterus, I have invented an adjust- 
able vaginal shield in the following manner: A frame of vulcanite 
varying in length from two to three inches, and appropriately 
curved. Its approximate extremity (Fig. 7, A) is open and neatly 
moulded so as to avoid pressure against the urethral ridge and allow 
the proximation of the vaginal walls. Its distal extremity is 
slightly bevelled, for the reception of the soft rubber band (Fig. 7, 
B), which passes around the end bar, and a German-silver wire that 
reaches from either side-bar one and one-fourth inch distant. Upon 
the upper surface of the inferior reflexion of the band is a sockes 
(Fig. 7, b) for the reception of the stem’s button, which it embracet 
effectively, owing to its shape and elasticity. This band is also per- 
forated in its upper reflexion with a number of eyelet-holes for the 
various adjustments of the stem, 
and for the use Of the introducing 
staff, as we shall see presently. The 
stem is adjusted to the shield by 
passing it from beneath, through 
the socket and upper eyelets, and 
finally causing the button to enter 
the socket. The insertion of this 
instrument may be described as fol- 
lows : First prepare the instrument 
by passing the introducing staff in 
front of the wire brace, then back 
through the eyelets, and cause the 
staff to enter the stem, by springing 
the button so as to admit it from 
beneath the diaphragm. By this 
manoeuvre the instrument is made 
to assume a compact and flat paral- 
lelism, and is as easily inserted as 
a Hodge’s pessary. (See Fig. 8, A.) 
“After lubricating thoroughly with 
castile soap, pass it into the vagina 
and guide the point of the stem into 
the os by the aid of the index finger. 
When the stem is within the uterine 
canal, gently withdraw the staff and 
reinsert it within the stem in the 
same manner as we would insert 
the uterine sound, and by its aid 
complete the adjustment of the 
parts and instrument as the circum- 
stances may indicate (Fig. 8, B); 
after which the staff is withdrawn, 
leaving all in situ. The attractive 
features of this instrument are ap- 
parent. It is light, compact, and 
safe. The stem cannot possibly 
become misplaced, neither can its 
bulb abrade the vaginal walls. It 
is also so pliable that it will not 
cause any arbitrary pressure of its 
point against the sensitive endo- 
metrium, thereby causing abrasion 
and serious irritation, so frequently 
produced by the rigid stem. The 
diaphragm of the shield is so resil- 
ient that it adds another. degree 
of pliancy to the stem, while the 
uterus finds in it an elastic cush- 
ion. By the aid of this vaginal 
portion, not only is the disagree- 
able tamponading abolished, but 
the vaginal walls are stayed, and 
by it the stem is made to assume 
any desirable angle by changing 
it into a forward, backward, or 
lateral eyelet. The instrument in 
this way can be adjusted for the 
treatment of every form of uter- 
ine flexion. The location of the 
socket is also easily altered by rota- 
ting the band. As we have seen, 
without withdrawing the instru- 
ment, we can readily ascertain 
the position of the uterus by intro- 
ducing a probe within the cavity of 
the stem, in the same manner as we 
introduce the uterine sound ; we 
thereby avoid the irritation produced 
by the removal and re-insertion of the instrument, and the objec- 
tionable manipulation of sounding the uterus.” 
Subinvolution, superinvolution, and non-development 
of the uterus, the author ascribes to atony of the capil- 
laries, which is the result of an unbalanced nerve 
power. We will quote a part of his argument: 
“ We should not overlook the fact that the blood-vessels are not 
the only agents in distributing the food supplies to the tissues, but 
are more properly the canals through which this supply is con- 
ducted, being-dominated by the nerve-fluid. 
“ To demonstrate our meaning take the phenomena of digestion. 
After a full meal succeeds a state of mental apathy and drowsiness ; 
the brain is comparatively inactive. Thus we are told that the di- 
gestive organs have engaged the nerve-power, for the time, in c n- 
verting the food into blood-supply. Should the rights of these organs 
be violated, by the withholding of the nerve-energy and diverting it, 
to the brain or other parts, digestion is suspended or but imperfectly 
Fig. 8, A.—Diagram illus- 
trating the manipulate of 
Donaldson’s flexion pessary. 
Pessary in position for in- 
sertion. 
Fig. 7.—Diagram showing Dr. Donaldson’s adjustable pessary for 
cure of flexions. A, shield; B, Section of shield showing band and 
socket; C, plain flexible stem ; D, galvanic stem—copper and zinc 
wire ; E, galvanic stem—copper and zinc bands insulated with vul- 
canite bands. 
eights of an inch in diameter. In this manner we secure an elastic, 
light, highly polished, and non-irritating stem, which can be bent 
to any desirable curve, but when unrestrained is persistently and 
gently self-erecting. For its retention in utero, and also for its 6 
performed. Should this perversion of the nerve fluid be persisted in, 
a diseased condition of the digestive organs becomes established. 
“ Now, who are the women who suffer most frequently from the 
results of capillary inertia of the generative organs ? Nine-tenths 
of these patients are what may be termed “brainy ” subjects. 
“ Their entire stock of neuric energy is exhausted in literary pur- 
suits, in painting, or more especially upon music. These delicately 
organized creatures have in some way acquired the belief that to 
respect the grosser bod.ly functions, is highly unbecoming, and that 
it is their duty to starve out all animal propensities for the fuller de- 
velopment of the assthetic tastes. Against this outrage of nature’s 
laws the nerves cry out, while, like any other neglected or starved 
object in nature, the abused and ill-nourished organs assume de- 
formities, and perform their functions in a miserable, imperfect 
manner. In the treatment of these cases, vigorous bodily exei eise is 
paramount; nevertheless, while we may succeed in establishing a 
the other (which he prefers) is an ingenious construc- 
tion of zinc and copper rings cemented together, and a 
number of these placed on a vulcanite rod, and insu- 
lated with vulcanite rings—the whole secured by a tip 
of vulcanite screwed on the point of the stem, B. In this 
manner he secures a voltaic pile, making the endome- 
trium the connecting medium. He claims that where 
the metals are in successive contact the transmis- 
sion of electric fluid is directly from one metal to 
another and comparatively slight through the tissues. 
Fig. 8, B.—Shows the stall reinserted within the stem after the 
perfect general circulation and muscular equilibrium, the long- 
standing local deformity usually continues.” 
For the induction of capillary activity, the absorp- 
tion of morbid deposit, and promotion of healthy tissue 
formation the intra-uterine galvanic stem is recom- 
mended. Dr. Donaldson seems undecided whether the 
energizing effect of the galvanic stem is attributable to 
the mechanical and chemical stimulus of this instru- 
ment, or to the electricity evolved. The latter- theory 
is maintained by Lawson Tait, and other eminent au- 
thorities. He is, nevertheless, convinced by experience 
that the galvanic stem is an efficient agent in imparting 
tone to the enervated tissues. There are two forms of 
instruments recommended, one of alternate copper and 
sine wires, in the form of a spiral spring, and flexible ; 
“ When the uterus is readily reduced and the posterior cervical 
portion is long, the pessary represented in the adjoining diagram is 
preferable. It is constructed upon the same principle as the previ- 
ously described pessary, only in this form the band surrounds the 
side-bars, which are slightly notched beneath the band to secure its 
stability. This will be found the better form of shield in the use of 
the galvanic stem B.” 
The prolonged presence of the galvanic stem within 
the uterine cavity is forbidden, as the salts of the 
metals resulting from chemical decomposition are 
capable of seriously injuring the tissues. He therefore 
advises the alternation of the galvanic with the plain hard 
rubber stem. The use of these appliances, constructed 
of parallel bars of zinc and copper, is pronounced highly 
injurious, they being apt to cause lateral cauterization, 
with subsequent cicatrization and contraction. 7 
Part first concludes with a brief consideration of the 
influence of the mental over the physical condition, 
giving us a glimpse into a deeply interesting field of 
thought. 
Part second is devoted to dysmenorrlicea, wherein the 
widely accepted theories regarding this subject are 
analyzed, and the usual operative procedures criticised. 
In this part, as in the former, the author insists 
throughout upon the importance of forming indepen- 
dent conclusions, and of taking a common sense view 
of the matter. 
We have not the space to include an abstract of his 
views respecting the etiology and treatment of painful 
menstruation, but regard this part of the work of equal 
merit, if not superior, to that already noticed. The 
book will be read with interest by all, and will be of 
profit to many. 
Those hypercritically inclined may object to the direct 
manner in which the writer attacks the views of older 
and more experienced authors, but his reasons for so 
doing seem good, and his argument convincing though 
somewhat sententious in style. 
The general practitioner will find in this work many 
valuable suggestions, while the specialist in this 
department cannot afford to remain unfamiliar with 
its contents.