NEW 
INTRA-UTERINE PESSARY. 
SECURED AND STEADIED IN POSITION 
SILVER SUTURE. 
V. H. TALIAFERRO, M.D., 
ATLANTA, GA„ 
PROP. OP OBSTETRICS AND DISEASES OE WOMEN AND CHILDREN IN ATLANTA 
MEDICAL COLLEGE; PRESIDENT OE ATLANTA ACADEMY OE MEDICINE; 
SECRETARY OP BOARD OF HEALTH OF THE STATE OF GEORGIA. 
ATLANTA, GEORGIA: 
H. H. DICKSON, BOOK AND JOB PRINTER AND BOOKBINDER. 
1877. NEW INTRA-UTERINE PESSARY, WITH NOVEL 
METHOD OF SECURING IT IN POSITION. 
Professor of Obstetrics and Diseases of Women in the Atlanta Medical College; President 
of the Atlanta Academy of Medicine; Secretary of the Board of Health 
of the State of Georgia. 
Y. H. TALIAFERRO, M.D., Atlanta, Ga. 
The objectionable features of the intra-uterine pessaries, 
are their tendency to excite inflammatory action in the uterine 
and peri-uterine structures, and the difficulty in retaining them 
in position. With these overcome, the intra-uterine stem is 
an instrument of great value, and applicable to a variety of 
conditions not amenable to other resources, as so often found 
in flexions, superinvolution, amenorrhcea, sterility, etc. 
The rather bulky instruments of Simpson, Kiwisch, and 
Valliex, adopted with great enthusiasm by their illustrious 
authors, yielded such unfavorable results as to bring them into 
much disfavor, and to well nigh cause, for the time being, 
their entire abandonment. 
Of late years, instruments of a more approved construction, 
together, doubtless, with our greater aptitude at diagnosis, 
and our better understanding of the contraindications to their 
use, have contributed, no doubt, to their present popularity 
with many gynaecologists. 
The special points to be observed in the use of the intra- 
uterine stem are: 
Ist. A fit sufficiently loose to make no undue pressure at 
any point, and which at the same time is sufficiently close and 4 
NEW INTRA-UTERINE PESSARY. 
secure in position to prevent any free motion of the instru- 
ment. 
2d. It should be perfectly secured in its position in the 
cervix, so that no slipping up and down is allowable. 
3d. It should cause no pain or uneasiness, either in its in- 
troduction or its continued use. 
4th. The point of the instrument, when introduced, should 
extend but little beyond the internal os. 
sth. The uterus should be free from any marked tender- 
ness or congestion. 
6th. The peri-uterine structures should be soft and elastic, 
and free from tenderness. 
7th. The instrument should be light and simple in con- 
struction, flat in shape, and preferably of zinc and copper, or 
copper alone. 
One of the chief difficulties in the use of the intra-uterine 
stem is to retain it in the uterus. When the uterine canal has 
its normal axis, any of the ordinary stems with vaginal bulb 
are readily retained, as the instrument abuts upon the posterior 
vaginal wall. If, however, as so frequently occurs in displace- 
ments, the uterine axis is brought more nearly in coincidence 
with that of the vagina, then the support of the posterior vag- 
inal wall is gone, and the instrument slips from the uterus into 
the vagina. Various devices have been resorted to for the 
purpose of meeting this trouble, all of which I think more or 
less objectionable. Those with expanding arms, whether of 
metal or rubber, are most reprehensible. 
Sir J, Y. Simpson used the lever pessary for the purpose of 
directing the os back upon the posterior vaginal wall, upon 
which the instrument would rest. Prof, Thomas, of New York, 
uses the lever with a rubber diaphragm as a support for the 
stem. These, while far preferable to all the means heretofore 
proposed for retaining the stem in position, are yet objection- 
able in many cases where it is not desirable to subject the 
uterus to the double stimulation of a vaginal and intra-uterine 
pessary. They are again open to the objection that the stem 
is not iixed in its position, and hence capable of a constant 
upward and downward play, from the almost incessant physi- 
ological movemnts of the uterus. 
In the simple stem here offered, with the method of secur- NEW INTRA-UTBRINE PESSARY. 
5 
ing it, I have endeavored to meet the indications and difficul- 
ties mentioned. 
The stem, as represented in the wood-cut, with silver wire 
and needle attached, is made of strips of sheet zinc and copper, 
such as obtained from the tin-shops, trimmed with stout scis- 
sors to any size desired, and the separate strips rivited to- 
gether. They can be made in any doctor’s shop in a little 
while. The stem is flattened antero-posteriorly, and adapts 
itself perfectly to the uterine canal without change of the nor- 
mal relation (antero-posterior approximation) of the walls of 
the uterus. 
The instrument is slightly galvanic, and hence therapeutic 
as well as mechanical in its action. As will be observed by 
the wood-cut, its proximal end has secured to it a delicate sil- 
ver wire, with small curved needle attached. The wire is fixed 
to the stem by passing it between the zinc and copper plates, 
and secured with a compressed shot. 
To apply the pessary, the patient is placed before a good 
light, in the semi-prone position, and the uterus exposed with 
Sims’ speculum. The anterior lip of the os is then seized with 
a tenaculum, and the uterus straightened out in the vaginal 
axis and steadied, while, with suitable needle forceps, the nee- 
dle—already attached by delicate silver wire to the stem—is 
made to pass immediately within the os and out laterally 
through the cervix, emerging just below the vaginal junction. 
The point of the needle is then grasped with the forceps and 
withdrawn. The stem is introduced in the cervix while the 6 
NEW INTRA-IJTERINE PESSARY. 
wire is being at the same time withdrawn, until both are in 
position. A small lead button is slipped down the wire, and 
on this a perforated shot, which is compressed and the wire 
cut close. 
A very correct idea of the operation is conveyed by the 
wood-cut, with the stem seen secured in position. The stem, 
as will be seen, is firmly and securely fixed in the cervix, and 
partakes of every movement of the uterus, and hence incapa- 
ble of the independent movements and friction of the ordinary 
bulb stem such as now generally used. 
When the galvanic stem is not particularly desired, the 
instrument may be made entirely of copper—one plate instead 
of two being used, thus making it just half the bulk and 
weight. 
The instrument may be worn, for an indefinite time, without 
risk of damage or inconvenience to the patient. While using 
them I direct that, after a few days from the introduction, no 
check be put upon exercise, either on foot or horseback. The 
same precautions as to dress are applicable here as in the use 
of vaginal pessaries, that the uterus may not be forced upon 
the floor of the pelvis by the pressure of tight clothes or cor- 
sets, and subjected to friction and concussions. The vaginal 
douche, of hot water, should be daily used while the pessary is 
worn.