Compliments of HENBY F. CAMPBELL. 
THE SOFT RUBBER 
SPRING-STEM PESSARY, 
IN THE TREATMENT OF 
Uterine Flexion^. 
‘ DANGERS AVOWED, BENEFITS SECUBED." 
Read before the Georgia Medical Association, Rome,-April 17th, 1879, 
Chairman of Committee on Gynecology for the Eighth District of Georgia, 
Professor of Operative Surgery and Gynecology in the Medical 
Department of the University of Georgia. 
HENRY FRASER CAMPBELL, M.D. 
[Extracted from the Transactions.] 
Atlanta, Ga.: 
Jas. P. Harrison & Co., Publishers, 
1879. THE SOFT RUBBER 
SPRING-STEM PESSARY, 
IN THE TREATMENT OF 
Uterine Flexions. 
“ DANGERS AVOWED, BENEFITS SECURED. 
Read before the Georgia Medical Association, Rome, April 17th, 1879, 
HENRY FRASER CAMPBELL, M.D. 
Chairman of Committee on Gynecology for the Eighth District of Georgia, 
Professor of Operative Surgery and Gynecology in the Medical 
Department of the University of Georgia. 
[Extracted from the Transactions.] 
Atlanta, Ga.; 
Jas. P. Harrison & Co., Publishers, 
1879. UTERINE FLEXIONS AND THE STEM-TREAT- 
MENT BY THE SOFT-RUBBER SPRING-STEM 
PESSARY. 
HENRY P. CAMPBELL, M. D., AUGUSTA, GA. 
In a former meeting of this Association, Savannah, 1875, 
I had the honor to present my views on the postural pneu- 
matic method of uterine reduction in versions and pro- 
lapsus. I still regard this as the only philosophic and effec- 
tual method of replacement in these several forms of uterine 
luxation. But in the class of uterine distortions, to which 
flexions belong, the treatment required, as has been admitted 
on all hands, is of an entirely different character. The 
trouble is intrinsic, and the indications of treatment are not 
to change a mal-position, but to correct a deformity of the 
organ. Various expedients are daily being proposed to ac- 
complish this object of straightening the flexed uterus, and 
while, to the minds of all, the stem-pessary commends itself 
as the most efficient and direct, the many evils, not to say the 
fatality, which have attended its use have, finally, resulted 
almost in its expulsion from the armamentarium of the gyne- 
cologist. Rings and levers to lift up and hold up the body and 
fundus from behind in retro-flexions, and from the front in 
ante-flexions ; appliances to push back or to hold forward 
the neck, and vaginal packings, for the same object, are daily 
presented as admittedly inferior but less dangerous sub- 
stitutes for the tempting desideratum of the internal splint, 
so mechanically appropriate to the accomplishment of the 
end. The fatal results experienced by Yelpeau, and his 
consequent condemnation of the stem, together with the Spring-Stem Pessary. 
4 
frequent disasters experienced by others, have been the prin- 
cipal cause of its exclusion from practice. Its history has 
been a varied one, but the testimony of experience lias been, 
of late, much more against than in favor of it. 
In a pamphlet on “Uterine Flexions,” published in 
1875, by my friend, Dr. A. Fredrik Eklund, of Stockholm,* 
we find the most valuable suggestions as to their pathology 
and treatment. He, with the late Dr. Martin, does not 
regard these distortions as simply mechanical bendings, 
caused by superincumbent weight of the heavy body 
and fundus upon the softened neck, but attributes to the 
longitudinal muscular fibres a dynamic instrumentality, 
similar to the altered and unequal muscular action which 
effects the deformity in club-foot and other analogous distor- 
tions, The atonic muscular fibres of the convex side give 
over the softened and passive neck, to the action of the 
actively healthy muscular fibres on the concave aspect, and 
by this means the flexion is accomplished, while the contin- 
uance of this action renders it permanent. With this view of 
the pathology accepted, he regards one of the important 
indications of treatment to be stimulation and restoration 
of tone to the atonic or paralyzed fibres, whereby the 
flexed neck or body may be brought back to its natural con- 
tour,, and the continuity of the canal restored. As the means 
of accomplishing the desired result, he reviews various 
methods of treatment, but gives preference, decidedly, to the 
use of the stem-pessary, both because it acts as a stimulant 
to awaken the proper tone of the paralyzed fibres, and also 
as an internal splint, acting “ orthopedically ” in restoring 
and giving permanence to the proper contour of the distorted 
organ. In substantiation of his recommendation of the stem 
* Till Betro-Jlexlonernas TEtiologi Och Thempi. Stockholm, 1875. Uterine Flexions. 
5 
lie presents a table of twenty-five cases, in which a perma- 
nent cure has been effected by the use of the stem under the 
strict and systematic rules given by him for its application. 
Deeply impressed by these views, and finding little or no 
satisfactory results from any of the various methods now 
recommended for the treatment of flexions, I have, for some 
years, endeavored to secure, as near as possible, the advan- 
tages of the stem-treatment without incurring the risks of 
cl O 
its actual application. In the repeated application of the 
sponge and sea-tangle tents, I have succeeded in many in- 
stances in accomplishing a straightening of the distorted neck, 
and in several women conception and prosperous pregnancy 
have been the result. I have found that by beginning with 
sponge-tents, made with a decided curve, little or no irrita- 
tion was produced, and as the case advanced towards a 
straightened condition of the canal the curve could be less- 
ened until perfectly straight ones could be used, after which 
the distortion would entirely disappear; then perhaps con- 
ception and pregnancy would occur when a permanent cure 
would be accomplished. 
As an additional force in the curved sponge tent treat- 
ment of flexions, I have thought well of, though never used, 
the enclosed watch-spring, suggested I believe, by Dr. El- 
lerslie Wallace, of Philadelphia, though even in this, the 
objectionable element of the sponge in contact with the mu- 
cous-membrane of the uterus restricts its value and renders 
its long application dangerous and undesirable. 
The results to be accomplished by the stem-pessary, pro- 
vided we could evade its dangers, being unquestionably de- 
sirable and superior to all other methods of treatment, it 
behooves us to inquire diligently what are the conditions and 
causes acting upon stems, which render their application so 6 
Spring-Stem Pessary. 
frequently disastrous, and not seldom fatal ? I give here 
the result of my reflections upon this important subject: 
Ist. Even in health, that is in the undisturbed womb, the 
mucous-membrane of the body and neck is of a most sensi- 
tive character, and liable to the awakening of inflammation— 
especially does it resent any mechanical aggression as the 
introduction of sounds, tents or probes, into the cavity of 
the womb. 
2d. In ante-flexion and retro-flexion, especially to the de- 
gree of stenosis, the natural sensitiveness of the cavity is 
greatly exaggerated. In nine cases out of ten, there is 
endo-metritis. It is the opinion of many that a pre-exist- 
ing endo-metritis, and perhaps some degree of metritis 
also is a frequent cause of the flexion. 
3d. In this condition of the lining membrane, and per- 
haps of the parenchyma of the womb, extension of inflam- 
mation to the entire structures of the organ, and to the pe- 
ritoneum and pelvic cellular structures, could very readily 
be provoked by the forcible introduction into, and retention 
in the womb of any of the ordinary forms of stem-pessaries. 
4th. The forms and materials of all the stem-pessaries here- 
tofore, and at present, used for the correction of flexions 
are entirely unsuited for introduction into the womb while 
in a state of flexion, especially when any degree of metritis 
or even endo-metritis is present:—Both in form and in mate- 
rial they are most dangerous because we cannot introduce 
a straight, stiff, hard rod into a curved, and still less into an 
angular canal—which doubtless has often been done—with- 
out injurious violence to the inner surface and structures of 
the womb. We curve the probe even for an examination 
in such cases, what are we to expect when the straight, 
unyielding stem is thrust in to remain as treatment! Uterine Flexions. 
7 
sth. When any of the ordinary or now existing: steins 
have been thus forced into the womb for the correction of 
flexions, the treatment is begun hy inflicting a very serious 
traumatic injury (bruising and contusion) upon the uterus. 
In addition to this, the sudden straightening and continued 
contact of the hard and resisting material with the tender 
surface still further advance and hurry on the process of 
uterine and pelvic inflammation which had been produced or 
aggravated by the violent and forcible introduction. 
6th. The very name of “pessary” as applied to the stem 
in common with the class of supporting pessaries—often 
misleads both the medical attendant and the patient, as to 
the amount of care and quietude necessary during the use 
of the former, as compared with conditions in which the 
latter are used. The one is a surgical appliance to some- 
what forcibly hold straight a hexed womb in opposition to 
an acquired tendency to an abnormal direction, and for 
some days at least, perfect quiet of body should be observed, 
while the other is simply a support to a descended or tilted 
womb, admitting of greater latitude of motion, and the 
taking of more extended exercise, than before it was applied. 
With the above considerations constantly abiding in my 
mind.—l have for years given to all sponge-tents used in 
the treatment of flexions a considerable curve with the fin- 
gers just before their introduction. Of late years, I 
have ordered my tents intended for this purpose to be 
made with a very decided curve in order that their intro- 
duction may be rendered easy and no risk run of traumatism 
in the tender organ to be treated. 
But as I have said, in the sponge-tent of any form, and 
also in the sea-tangle tent we have but a poor substitute for, 
and one little less dangerous than, the hard stem itself. In 8 
Spring-Stem Pessary. 
the instrument I now present, I have endeavored to secure 
all the advantages in the cure, of easy and innocuous in- 
troduction, and also those of softness and pliability of ma- 
terial with yet sufficient strength to act as a splint in main- 
taining straightness. 
It consists of three distinct and separate parts : 
THE SOFT-RUBBER SPRING-STEM PESSARY. 
A. —The soft-rubber stem and spring prepared for introduction. 
B. —Shows the spring separately. 
C. —The rubber cap or hoed. 
Ist. An applicator upon the plan of Emmett’s or the 
sponge-tent applicator modified for this purpose, with a spi- 
ral wire protrusor which can be pushed beyond the curved 
end without injury if any degree of care be given to this 
work. 
2d. A spring which can be made of any degree of weak- 
ness or resiliency, and which is to be slotted on to the curved 
end of the applicator, and 
3d. A piece of india-rubber tubing similar to Nekton’s 
catheter closed at one end, which is to be pushed as a cover 
over the spring as adjusted on the applicator. 
A string should be applied through the two smaller holes 
of the plate at the proximal end of the spring—in order to 
withdraw the spring from the uterine and cervical cavity 
whenever necessary. Another string or thread (of differ- 
ent color) should be attached to the rubber tube in order to 
withdraw that too, should it be desirable. The present Uterine Flexions. 
9 
specimens have been made for me by Messrs. Geo. Tiemann 
& Co., of New York, from models not altogether perfected 
in every particular, but they will answer to give the correct 
idea of the object intended. 
The spring may be of any degree of strength or feebleness 
—or after the introduction of the tube alone by the applicator, 
a very flexible piece of whalebone or gum-bougie may be 
pushed in, to give the stem just the slightest degree imagina- 
ble of resiliency to correct, however gradually—and tenderly 
as we please—the aberration in form of the even inflamed or 
irritable womb—or possibly the simple presence of the tube 
itself may be sufficient, upon the idea of Eklund and Martin, 
to awaken the tonicity of the relaxed fibres which had been 
instrumental in the flexion. When once the tube has been 
placed, any kind of stiffner may be safely introduced with- 
out any danger or fear of injury to the mucous membrane 
of the womb. It is both the guide and the guard for stems 
of any kind whatever we may choose to use in correcting 
the distortion. 
In the majority of cases, the previous introduction of a 
curved sponge-tent will be required to dilate and slightly 
straighten the angular canal, in order that the curved spring 
and its soft-rubber cover may enter without the exercise of 
force, A ring pessary may be required sometimes, to sustain 
in cases of prolapsus, and possibly a cotton tampon may add 
to security of retention for the stem. 
The foregoing instrument I now oiler to the profession as 
one which in its material, and form, and in its mode of appli- 
cation. as also in the results which may not unreasonably be 
anticipated from its use, wTe can hope in time will be found to 
supply all the desiderata of the stem-pessary, while it is de- 10 
Spring-Stem Pessa/ •;/. 
void of most of its dangers, as v 11 as those of the sponge 
and sea-tangle tents. If such are its attributes, is it too 
much to claim that perhaps a “ new era ” in the stem-treat- 
ment has been happily inaugurated ?