[Publishetmn the Eclectic Journal of Medicine, Vol. 11. No. 3.—January 1838. 
Edited by John Bell, M.D., Philada.] 
ON 
THE USE AND ABUSE 
OF 
®2HH IPUSSAIB^o 
S7 JOHN T. SH ARTLESS, M.D .. 
OF PHILADELPHIA. 
[Read before the Philadelphia College of Physicians, Dec. sth, 1837.] 
In the year 1826, I published a paper in the Philadelphia Journal of the Med. 
and Phys. Sciences of this city, in which I enumerated a series of morbid symp- 
toms which I considered depended upon a descent of the uterus from its natural 
position. At that time, the generality of physicians approved of mechanical 
means to restrain, and even cure, acknowledged cases of that disease. The 
point of my paper was simply to designate particular combinations of symptoms 
that I thought depended on such a source of irritation, whilst the mass of the 
medical public were not aware of the true cause, and also to recommend the oval 
or notched pessary (although not a new shape) for particular cases. Since that 
time, many very respectable physicians have denied that prolapsus was the 
immediate cause of certain well-known symptoms: and when that disease be- 
came nearly or quite self-evident, discarding the pessary entirely, they have de- 
pended on rest, &c., for the cure, or the application of a simple bandage to retain 
the organ in the vaginal cavity.* 
With these discrepancies in medical belief and practice, it is of the first im- 
portance to suffering female humanity to determine, if possible. 
Firstly : TV hat causes can produce certain symptoms, usually considered, as de- 
pendant upon what is termed Prolapsus Uteri 1 
Secondly : Under what circumstances can these symptoms he relieved hy mechani- 
cal means, and which are the best inventions for the purpose ? 
It has become a melancholy truth, that through the operation of climate, 
habits, or other causes, the females of our country have become, of late years, 
exceedingly subject to uterine affections. When in Europe two years since, I 
took some trouble to learn if such diseases were on the increase in that part of 
the world, and if they could possibly be as rife as with us. From what I as- 
certained, on the best medical authority in London and Paris, I was induced to 
• Doctor P. K. Eve, in an essay in the South. Med. and Surg. Jour., condemns 
the use of the pessary entirely, and cannot conceive of any case requiring such a mean 
of cure. In aid of his opinion, which he acknowledges is founded upon no experience 
of his own, having never used one, he adduces the evidence of some of the very res- 
pectable physicians of the south, several of whom condemn them, and others think 
their employment has been much abused. The argument and most of the evidence 
merely prove the latter opinion, and that, like many other invaluable remedial agents, 
the pessary is in the descendent, and becoming unfashionable, and therefore will be 
soon entirely useless. The positions of Doctor Eve are, I think, entirely disproven in a 
reply by Doctor Antony, one of the editors of the Journal. 2 
Sharpless on the Pessary. 
believe, that, although those maladies were very frequent, and cancerous ones 
more common than with us, yet the proportion of uterine affections was less 
than in the United States. What the causes are that produce these destroyers 
of female health and comfort in our country, it would be difficult to ascertain; 
but, from the frequency with which we see several members and even genera- 
tions of a family afflicted with them, it would seem, either, that the germ of dis- 
ease, or a conformation that was peculiarly susceptible to the operation of 
causes to produce or develop the malady, was hereditarily transmissible. 
The latter is the principal that can be said of what is called hereditary 
phthisis, and the same tubercular diathesis that generates consumption in one 
member of a family, will produce chronic diarrhoea, chronic hepatitis, disease of 
the spine, or uterine derangements in others. 
Curious as it may seem, our trans-At]antic growth, or culture, has effected con- 
siderable change in the actual shape and proportion of various parts of our sys- 
tem, as indicated, by Cuvier, in the shortening of the upper eye-lid, and as 1 have 
observed myself, and no doubt others have done the same, in the contracted 
chest of our females, whilst the cavity of the pelvis is enlarged, with an increased 
distance between the hip and lower ribs. 
A fruitful secondary cause of uterine diseases, is, I fully believe, the system 
of tight dressing, with a stiff or even unyielding “ bone” in front. The unna- 
tural compression in all cases, of the internal organs by these “ straight jackets" 
is easily understood, whilst the support below being lessened by the increased 
cavity of the pelvis, and a diminution of the usual lateral protection by the width 
of the unribbed flank, (mentioned above as a peculiarity,) render the lower 
viscera more likely to be forced down, and in this confined or even compressed 
condition, they become, of course, more subject to disease. It is this lateral 
compressibility that gives our American ladies the reputation, over the world, 
for beauty of waist. Even the front bone is no doubt a source of mischief, for, 
in stooping, it presses into the abdomen just above the pubis, and its replace- 
ment, after apparent cure of the Irritable Uterus, has, in several instances in my 
practice, produced serious relapses. For months, therefore, after all manifest 
disease has disappeared, I forbid the restoration of the “ bone,” or of lacing the 
jacket below the true ribs. 
A very frequent cause of chronic uterine disease is, too early maternity, and 
I think I am safe in saying, that a majority of marriages under seventeen or even 
eighteen years of age in the female, is followed by some such derangement. 
The reason is easily understood. The immature female structure is called upon 
to perform a duty, in a feeble condition, that should only belong to a full deve- 
lopment and perfection of health and strength, that, in our climate, does not ap- 
pertain to that age. 
I now come to the First regular division of my subject, or, What causes can 
produce certain symptoms, usually considered, as dependant upon what is termed 
Prolapsus Uteri ? 
These symptoms of prolapsus are fully detailed in my essay referred to, and 
most of them can be found in other works on the same subject. 
No physician has, I believe, the temerity to,deny the existence of all these 
symptoms in various cases; the opposers of the pessary merely dispute a 
“ falling of the womb” as the cause; for, say they, “we find all these very com- Sharpless on the Pessary. 
3 
plaints when there is no perceptible certain displacement, as determined by the 
touch, and in cases where the uterus has descended considerably, and has even 
appeared externally, there are often no such symptoms found.” Let us, for a 
moment, inquire, what is the natural situation or elevation of the womb, and how 
can any man determine, in many cases, by the finger or any other means, when 
a morbid descent has occurred. 
During many years of extensive practice, with my attention particularly di- 
rected to uterine derangements, I have very often found myself utterly at a loss 
to say whether the organ was in its natural position or not. Anatomists inform 
us that the os uteri is found about three inches from the external orifice. Now, 
I am certain that I have felt the uterus, that appeared to be healthy in all its re- 
lations, less than two inches, and in other cases nearly four inches, from the os 
externum; and this difference depending on the size of the pelvis, a deep and 
narrow chamber holding the uterus higher than one that is shallow and wide. 
This latter description of cavity is more generally associated with “real pro- 
lapsus” and easy labors, whilst the former is prone to produce, by its contrac- 
tion, the more active diseases of the womb.* 
The majority of index fingers are about three inches in length; and it depends, 
very much, upon the position of the patient and her fleshiness, if we can reach 
an uterus that is three inches from the opening. This is sometimes impossible, 
unless the limbs are much flexed, and some force employed. Moreover, what do 
we gain by a horizontal examination, unless adhesions have bound the organ to 
its unnatural situation. By getting the patient to strain moderately, or cough, 
we can form some idea of its ability to descend ; but an upright posture of the 
body with the limbs together and flexed—as sitting with one limb entirely over and 
the other on the edge of a chair, and which allows the examination to take place 
with the patient’s back to us, and therefore in as delicate a manner as when in 
bed, can alone determine its relations during walking. Granting, therefore, the 
positions of the Antipessareans, it will be difficult for them to prove, in many 
cases, that there was, or was not, an unnatural descent. Suppose a case. We 
have a certain set of painful symptoms—examination finds the womb one or two, 
or even three inches from the external opening; there is no enlargement, or en- 
gorgement, or tenderness, or indeed any indication of local disease ; what shall we 
call it, and how treat it 1 A name does nothing but convey an idea, and if we 
expel from our practice a mean of almost certain relief in such cases, merely be- 
cause it does not always cure and may sometimes do harm, we might extend the re- 
form to all the materia medica. I never use a pessary for Prolapsus Uteri alone. 
It must bring with it a cortege of pains and distresses, for which I prescribe. 
I care little w’here the uterus may be, unless I find from its position externally, 
* It has been doubted by many physicians, that prolapsus, without enlargement of 
the uterus, could occur in virgins, from the naturally contracted and firm state of the 
vagina; but I have certainly, on several occasions, found the os tincae of an uterus of 
natural size within one inch, during uprightness, of the internal labiae, and at this mo- 
ment I have a patient with an os externum so contracted that the finger enters with 
difficulty, and the uterus is met in half an inch from the labia; even in a recumbent pos- 
ture. If an uterus in that situation, and accompanied by all the usual symptoms of 
“ falling,” can be called prolapsed, there is no question of the existence of such a 
lesion in virgins; but I have never met with such a case without great irritation being 
found in the uterus and vagina. The displacement in these cases probably occurred 
from a violent exertion, and the irritation, from the compressed situation of the organ. 4 
Sharpless on the Pessary. 
that disease will soon follow, and I then merely use a bandage and pad or other 
contrivance of the kind to retain it in the vaginal cavity. It is the symptoms, 
commonly considered as dependant on prolapsus, that demand attention, whether 
there be apparent “ falling” or nat. These very symptoms are often found where 
there is no physical reason to believe there is a true “falling.” This has oc- 
curred in my practice many times, and where I could find neither in the spine, nor 
elsewhere, any satisfactory cause for the distress. In these cases, recumbency en- 
tirely relieved, as it does in prolapsus. Now, what can be the source of all these 
pains ? I would say, it arose from a neuralgic,* or an irritated condition of the 
upper supports of the organ, or of the surrounding parts, by which neither the ordi- 
nary weight nor motions could be borne without the production of distress. We 
all know the excitability and extended influence of the Sympathetic nerve, and how 
closely its interests and peace are interwoven with those of the viscera of the 
pelvis. It requires but little to arouse it, and when affected its turbulence is 
felt to the extremities. The Spine should never be neglected in these cases, as 
there is a reciprocal sympathy between it and the contents of the pelvis. This 
Neuralgia may also be found in the body or neck of the uterus, and will simulate 
every evidence of “ falling.” There is usually great tenderness on pressure, 
and perhaps some tumefaction per vaginum, and it will sometimes come or as 
suddenly as a blow, and produce the most violent torture. I have recently had 
an instance in a married lady of seventeen years of age, where a strain in the 
performance of faecal duties brought on excessive agony. Examination inter- 
nally detected great tenderness, but no displacement, and some hours elapsed 
before relief, when the uterus had ceased to be painful to the touch. Neuralgia 
of the uterus may become chronic, and be relieved, or not, by recumbency. It 
may also extend to, or be found alone in, the vagina, and produce the same 
symptoms, and from nearly the same cause as when in the ligaments, it not 
being able to bear the weight and movements of the superincumbent organ. 
There is sometimes a thickened and extremely painful condition of the whole 
perinaeal mass, which does not depend on inflammation or its consequences, but 
pressure upon it by the finger from within outwards is often agonizing. 
The weight of the viscera upon this tender flooring is almost insufferable, 
and be felt over all the lower body. All the various Engorgements and Indura- 
tions, whether acute or chronic, of the body and neck, will assume most of the 
phenomena of prolapsus, and which do not appear to depend entirely upon the 
depression that the increased size and weight of the viscus would naturally 
produce. I presume nervous irritation to be the cause in a great measure. 
The ordinary superficial ulcer of the os tincae (as discovered by the speculum) 
I have known, often, to cause the most extended abdominal and spinal distress, 
and even to give that curious pain under the ribs which has been considered 
almost pathognomonic of prolapsus. That the ulcer was the cause, was proven 
by the removal of all discomfort, by its healing, whilst absolute rest, astringent 
* I mean by JVeuralgia that nervous tenderness that is independent of inflamma- 
tion. It may attack a part sensibly organically diseased, or may be found in structures 
apparently in perfect health. The nerves, in these cases, may remain morbidly sensi- 
tive for a long time, and yet not affect the blood-vessels, producing neither thickening 
nor redness. Irritation is the first stage of inflammation, and cannot exist without 
producing a change of structure to a certain extent. This stage may exist a long time, 
and yet develop little of the active inflammatory character. Sharpless on the Pessary. 
5 
washes, and the pessary had entirely failed. I have also met with cases, where a 
loose, flattened tumor, conveying the idea of an ovary, could befeltuery high up, 
sometimes on both sides, pressure upon which gave excruciating pain that darted 
up to the flank just above the hip, particularly on the left side. I can also recall 
several instances, and one in particular that occurred last spring in a lady from 
New York, where excessive abdominal and pelvic distress had been felt for 
years, and where, upon examination by the touch, the only indication of disease 
that could be found, was the existence of several extremely tender glands or 
tumors of the size of peas between the uterus and just below the projection of 
the sacrum. 
An irritable or inflamed bladder, with or without the presence of a stone, will 
simulate prolapsus. 
I have had under my care a case where the descriptive symptoms in- 
duced several of the most eminent surgeons and physicians of our city, in- 
cluding Doctors Physick and Dewees, to consider it a decided uterine disease 
of some kind ; but where, upon examination, that organ and its immediate 
connections were found sound and in place. The urethra was at last discovered 
to be the seat of the evil, and the application of caustic to its entire inner mem- 
brane by Dr. G. M‘Clellan has now nearly removed the most distressing suffering 
that could well be conceived, and which had defied, for several years, the most 
elaborate plans of practice. 
Secondly : Under what circumstances can these symptoms be relieved by mechani- 
cal means, and which are the best inventions for the purpose ? 
Where a pure, uncomplicated prolapsus occurs, attended by the usual painful 
indications, the proper employment of a suitable pessary will, in a very great 
proportion of cases, remove most, if not all, of the symptoms ; and unless age, or 
the long duration of the disease, or absence of general health prevent, it will, 
with good management on the part of the patient, in time, often entirely cure. 
Confinement for months, injections of various kinds, &c., although occasionally 
useful, I believe, are far less successful in the result. I have fully tried almost 
every plan of practice that has been proposed, and am assured that the proper 
use of a pessary is not only the least disagreeable, but the happiest in its effect 
of any mode of cure thus far discovered.* I have seen cases that from idiosyncracy 
could not bear the constant presence of a foreign body in the vagina, although 
the indications for its use were manifest. Here, palliatives or other plans of re- 
lief become the only resource. The truth is, there are few cases even of simple 
displacement that will bear a pessary without some preparation, and the great 
error has been in their indiscriminate employment, and without the preliminary 
treatment. I presume, most physicians, whose attention has been drawn to 
uterine diseases, have observed that there are fewer cases of uncomplicated 
prolapsus wore than there were a few years since, and the more serious engorge- 
ments, &c., have succeeded. 
* There is a restless, dissatisfied temperament occasionally met with in the treatment 
of other diseases, which, after a real suffering for years, allows the imagination of the 
patient to become so identified with the genuine symptoms of the malady, that when 
the disease has really gone, the ideal sufferings remain as acute as ever. This is parti- 
cularly the case in prolapsus, and the patient will often think herself unrelieved, when 
the indubitable external evidences of perfect health have convinced, to the contrary, 
every one but herself. 6 
Sharpless on the Pessary, 
To understand the principle upon which an internal mechanical support re- 
lieves, let us inquire, what change takes place in the position of the uterus in 
prolapsus, and its degrees. When in its natural situation, and the subject stand- 
ing, it is, I believe, usually found parallel in its long diameter to the line of the 
sacrum, and therefore points downward and backward at an angle of perhaps 
seventy degrees. When it has descended a short distance, it becomes perpendi- 
cular ; and when it reaches and lies upon the floor of the cavity, it reclines on its 
back nearly horizontally. When a flat pessary is introduced, if the organ be 
very high, it is probably not reached by the instrument at all; if half descended, 
and the pessary resting horizontally, the cup receives the os tincae at a right 
angle with its own diameter ; and, as the vagina appears to me to be an inverted 
conical cavity, the instrument ascends, carrying the organ with it, until it 
reaches a space of its own size. Of this fact lam practically well assured, 
and therefore increase the diameter of the pessary as much as possible without 
producing pain in the wearing ; finding, in a vast many cases, that a large sup- 
port will ascend almost out of reach and relieve proportionably, whilst, in the 
same patient, one of less diameter will uselessly rest upon the perinanim. When 
the viscus lies upon the floor of the cavity, as in the second degree of “ falling,” 
the pessary, instead of receiving the uterus perpendicularly, supports it as it lies, 
nearly across the cup, lifting it from the irritated and irritating membrane, and, 
although a foreign body, it does often, notwithstanding the outcries of the unbe- 
lievers, act like a charm in giving relief. Dr. Dewees once remarked to me, he 
did not care for the size of the instrument, so that it was retained,—a small pes- 
sary, if it could be held, relieving as much as a larger one, every condition of 
descent. In this particular, I take the liberty, however presumptuous, of differ- 
ing. In his published cases, perfect relief appeared to have been obtained by an 
instrument, the floor of which, and where the os tincae would rest in the first de- 
gree of displacement, was not more than two lines in thickness; and if the machine 
did not ascend, as I have just supposed it to do with a large pessary, it could only 
have raised the viscus that distance. If the “ falling” was in the second degree, 
the sides of the pessary supported the recumbent body, and elevated it their own 
thickness, which was perhaps half an inch. The benefit from a small pessary, 
therefore, must have been derived, in a great measure, from a prevention of the 
friction of the uterus on the sides and bottom of the vagina during its perpendicular 
and lateral swinging, as in walking, by steadying it, and keeping the irritated sur- 
faces apart, and also by a slight distension of the canal producing a tonic and firmer 
condition of the inferior uterine support. If the finger be introduced where a 
small pessary is worn, with the patient in an upright position, the front edge of 
the instrument can be felt offering at the opening, and ready to start out, and not 
standing across the pelvis, as many suppose, with the front edge up behind 
the pubis. It merely lies there supported by the perinaeum, and kept from 
escaping by a contracted os externum. vaginae were of the same shape, 
the effect of an instrument that would occupy the entire cavity of what should 
be the proper extent-of the vagina (as Cloquet designed in his pessary predicated 
on a cast of the chamber,) and that wmuld have an unvarying point of support, 
could be reduced to a mathematical certainty ; but the instrument is yet to be 
invented or applied, that will, either by resting against the junction of the uterus Sharpless on the Pessary. 
7 
and vagina, or by supporting the viscus itself, hold it in its proper elevation and 
position, and yet have a firm and unchanging point d'appui for itself.* 
Neither is the globular formf in accordance with the philosophy of the matter; 
it gives, moreover, an unnatural obliquity to the neck of the uterus, whilst the 
depressed globe has never, in my experience, retained the os tincae in its cavity. 
I here mean one that is merely depressed on one side, and without any aperture, 
for a very thick “ flat” approaches in its form a globe deeply indented on both 
sides. 
The disrepute that has befallen the pessary, has arisen, in great measure, 
from our very imperfect knowledge of its modus operandi ; and, consequently, of 
its correct form and application. As 1 have alluded to the subject of my essay 
of 1826, I will here remark, that a more enlarged experience has satisfied me, 
that the very cases where I considered the notched or figure-of-eight flat pessary 
most required, can be managed with less difficulty and danger of displacement 
by the circular and globular. The ordinary fiat pessary I consider almost useless 
from its thinness, and therefore select those that are an inch in thickness, with 
just depression enough to give a bed to the neck ouffioi»gwt to lead the secretions 
through the aperture.X 
I will here mention an occasional consequence to the introduction of a pessary 
that, unless understood, will cause anxiety, and frustration of the benefit of this 
agent. In prolapses of long standing, with great descent of the organ, the super- 
incumbent viscera, even to the stomach and liver, and perhaps higher, follow the 
lower supports, and sink below their natural position. When a large globe, 
for example, is introduced, the uterus is forced upward, and the superior organs 
are crowded on each other to such a degree, that violent pain in the side, flatu- 
lence, swelling, and tenderness of the abdomen, and even difficulty of breathing, 
have been produced. These annoyances have, in several instances, been so 
alarming, that I have been solicited to remove the offending body, wrhere a 
few days of rest have dispelled every unpleasant feeling. 
Of Hull’s abdominal supporter, and a somewhat similar contrivance of Dr. 
Annan, of Baltimore, I will merely remark, that where the uterus is disposed to 
pass through the os externum, or even to press hard upon and distend the peri- 
naeum, they are, perhaps, the best external applications that we have; but they 
• Dr. Meigs has lately used a pessary, which he considers promising in its effects 
thus far, somewhat of the shape of the outer frame of a shoe-buckle, but very light, 
which operates against the posterior junction of the uterus and vagina, and passes up 
behind the pubis. 
Dr. Reynell Coates has placed in my hands for trial a model of another form, which 
I have not yet employed, but which appears to me well worth the experiment. It will 
act on the same principle as that of Dr. Meigs. 
f When I have occasion to employ a globe, I prefer those of glass, without any 
aperture, the weight of this shaped instrument being of little consequence, although of 
much importance in the flat. I can extract them with the greatest ease by a small 
vectis of my own invention, with a blade of a different rotundity at each end. 
t The contact of any foreign body with a mucous membrane will usually increase 
the natural secretion of the part, and hence the introduction of a pessary will be often 
followed by a discharge. Unless this becomes extreme or diseased, it does not mate- 
rially interfere with the usefulness of the agent, and an astringent injection will often 
restrain it. The most effective remedy in all unnatural or increased secretions from 
mucous surfaces, whether of the vagina or elsewhere, unaccompanied by inflammation, 
is the solution of the hydriodate of iron in doses of from five to thirty drops, three times 
a day, according to the strength of the stomach and bowels of the patient. 8 
Sharpless on the Pessary. 
can only retain the organ in the cavity, and, by supporting the fallen viscus, 
relieve some of the distresses incident to that condition. I consider an abdo- 
minal support of great service in many cases where the bowels feel as though 
the subsidence of the lower viscus had produced an aching void that required 
pressure to relieve.* 
I will now describe other conditions of the organ where I have known the 
pessary useful. 
In great fulness or prolapsus of the vagina, I have seen it do much good. In 
a case, in this city, there seemed to be almost double the usual quantity of mate- 
rial in the vagina, with the uterus healthy and in its natural position, and yet the 
patient suffered most of the indications of prolapsus of that organ. 
All other applications having failed, a flat pessary was introduced that soon 
buried itself in the redundant duplications of the canal, and has excited the vis 
tonica in the part so much, that it has shortened itself nearly one half, and with 
great relief of previous distresses. 
In the neuralgic vagina previously mentioned, the sensibility is often so exces- 
sive, that an examinatioo.tO.any extent is entirely precluded, and yet there are no 
evidences of inflammation cfr* change of structure. In these cases, depletory 
treatment does no good, and although perfect rest and sedative applications 
partially benefit, the sensitiveness of the part will remain for months. These 
cases 1 treat on the principle long practised in the same condition of the rectum 
and urethra, by the bougie. These I have made of gum elastic of various sizes, 
and the patient employs them herself, commencing with the largest that she can 
introduce without much suffering. This is retained until all pain ceases, and 
when a certain size can be used without any inconvenience, the diameter is 
increased. They should never be introduced unless the patient is recumbent, 
and great care should be taken to avoid striking the womb, as inflammation 
might thereby ensue. I occasionally use some sedative ointment upon themf to 
assist in the relief. In all cases they should be covered by some oily or mu- 
cilaginous substance. This treatment is almost a specific for that distressing sen- 
sibility that has been found heretofore so difficult to cure, a few days being often 
sufficient to remove tenderness of several months’ duration. To prevent a return 
of this neuralgic condition, even where there is no prolapsus, a pessary will con- 
tinue the same principle of action, and should be worn for some time.£ The 
bougie is also extremely useful in dilating the os externum in other diseases of 
the parts, to permit the introduction of a pessary of sufficient size to be of perma- 
nent benefit, thereby avoiding the exposure and pain of a frequent change of 
instrument^ 
* A very convenient and easily-constructed arrangement consists in a band of 
strong muslin sufficiently gored to fit closely over the hips, and reaching from the 
middle to the lower part of the stomach. Bones may be fixed to keep it spread on the 
back, and the lacing should be in front, with strong tapes to pass between the limbs to 
keep it in its place. 
f As Opium or Belladonna. 
i A silver pessary, connected by a wire with a zinc plate placed on the spine, would 
no doubt be useful in many cases where a galvanic operation would be serviceable. 
Clark’s modification of Saxton’s electro-magnetiser has been very beneficial in my 
hands in these very cases. 
§ In cases where leeching the uterus is necessary, there is often great contraction of 
the external orifice, and the introduction of a tube of sufficient size for that object is 
prevented. Here, the bougies will soon prepare the parts for all necessary purposes. Shakpless on the Pessary. 
9 
In Neuralgia, or irritation of the upper ligaments, where the ordinary weight and 
motion of the uterus cannot be borne, the pessary, even if it does not reach the 
organ, steadies and supports the parts so much as to be of great service. 
In the cases mentioned of tender glands, or bodies between the uterus and 
sacrum, the pessary effected a relief of the violent pains, and the tumors disap- 
peared; and although the uterus did not seem, upon the removal of the pessary, 
to have acquired any permanent increased elevation, the distress has not returned. 
A young lady of this city had felff'annoying abdominal and pelvic pains 
for several years, which had been believed by her physicians, several having 
been consulted, to arise from an extremely tender tumor of the size of a pea, 
near the os urethra, the agony appearing to commence at that point, and extend 
up into the body. The tumor was removed by Dr. J. R. Barton, with considerable 
relief. It, however, soon returned, and with it all the previous suffering. Fre- 
quent spasms, accompanied by entire loss of consciousness, had afflicted this 
lady for some years. Upon being called, I discovered an irritable, depressed 
uterus, which, by suitable treatment, soon lost its painful character, but upon 
renewed motion many of the former symptoms returned. A pessary was now 
introduced with immediate relief, the tumor disappeared, and every indication of 
permanent health has since continued. 
In the case of a lady from a far southern state, I found a violently irritable 
tumor of the size of a filbert surrounding the os urethra, which had been accom- 
panied by the usual annoyances of a real prolapsus for several years, to so great 
an extent, that she had been confined to her bed on several occasions for months, 
much to the destruction of her general health. Nothing was done for the 
tumor, but the uterus was supported by a pessary for five months, with the most 
triumphant success in removing every disagreeable local as well as general 
symptom of disease, and among which was a most incorrigible dyspepsia. The 
pessary was removed after she left my care by a western physician, travelling 
having excited a slight vaginal inflammation, and she informed me this summer, 
that there has never been a return of her former ailments, although several years 
have elapsed since the treatment. 
We often find by the speculum* a redness and thickening, or ulceration of the 
mouth and neck, accompanied by all the afflictions that usually accompany pro- 
lapsus. By rest, leeching, and other suitable applications, all the ulceration, 
and perhaps the redness, will disappear, but the thickening and tenderness will 
* Until the employment of this aid to our observation becomes more general and 
unrestrained in our country, we can never practise in uterine diseases, in that philo- 
sophical and successful manner that becomes the medical men of the present day. 
This prescription for maladies unseen, and I may say, in many cases unknown, al- 
though compatible with the delicacy that is perhaps mote the pride and ornament of 
American women than those of any other nation, partakes so much of quackery, and 
is so often utterly useless, that it becomes the duty of every conscientious practitioner 
to insist, in all cases where he considers it absolutely necessary, to be allowed the evi- 
dence of more senses than one. The manner of solicitation for, and practice of, the 
privilege, will be dictated by the refinement of feeling of every man who has a just 
appreciation of the modesty of the sex. The speculum I employ, and which I have 
used in a great number of cases since my return to America, is the bivalve of Doctor 
Ricord (Paris). He devoted much time to showing me the application and benefit of 
the instrument, and I witnessed the examination of near one hundred cases of various 
uterine derangements. It can be used with the most perfect ease, without the least 
pain, or exposure of any part but the mere neck and mouth of the womb, and in no 
case need a more complicated contrivance he required. 10 
Sharpless on the Pessary. 
often remain for some time, with a constant liability to relapse. In many in- 
stances, with the healing of the ulcer, all sensible inconvenience will be re- 
moved ; but to protect the delicate cicatrice, and prevent a reexcitement of the 
disease, by the friction of the parts, I introduce a mere ring, which does not touch 
the mouth, but which allows the new surface to harden. This practice I have 
found of great use. I have even successfully depended on the ring with mild 
injections to remove some ulcers of long standing. 
In Hypertrophy, whether the other disease, or an “ exaggeration of 
nutrition,” where the dragging and other symptoms demand particular treatment, 
there is nothing to compare with the pessary. The prolapsus in these cases is 
generally from increased weight in the organ. 
In a majority of cases of Acute Metritis, after the subsidence of the inflamma- 
tory stage, I introduce some mechanical support either of sponge or harder ma- 
terial for a short time, and I am fully assured that the congestions and chronic 
enlargements that so often remain, may be avoided by supporting the organ. 
We thus prevent the displacement that would occur from the increased weight, 
and by giving the patient fresh air and gentle exercise as early as is proper, we 
allow the viscus to recover its natural bulk in its proper situation. 
In Engorgement, or Induration,* either simple or scirrhus, of the whole organ 
or in part, without inflammation, I do not mean slight tenderness, for that is 
found in almost every morbid condition of the uterus, I try the pessary when- 
ever the dragging, &c., becomes troublesome, and often with great benefit. In 
Some of these cases, the diseased viscus descends almost to the external open- 
ing, and forms adhesions, so that, immediately upon passing the internal labiae, 
the finger meets a mass of hard matter that has no resemblance to the neck or 
body of the womb. I have recently had a case of this kind in a lady eighty 
years of age. Four years since I found her nearly in this situation, and sufferng 
from excessive dragging, with great pain in the back and stomach. After some 
difficulty, a pessary was retained with perfect relief. Within a few months of 
the present time, imagining she was permanently cured, she begged the removal 
of the internal support, but in a few weeks she reapplied to have it restored, her 
old sufferings having returned. By this time, the diseased mass had descended 
into and closed up the vagina so much, that a very small pessary required the 
aid of a bandage to retain it until it had made a lodgement for itself. This was 
effected in a few days, and then a larger one was used, and, in the fourth 
change, her old instrument was restored, since which time she has felt no 
inconvenience. 
Another case has occurred to me, which not only proves the usefulness but 
the harmlessness of the pessary. A lady wished one removed that she had 
worn for twenty-eight years, which had never incommoded her, but she feared 
it might produce other diseases. She had been, during the whole time, free 
of the symptoms for which it had been applied. After some difficulty, an oblong 
hoop of rope was extracted, that, she said, was once covered with wax, but 
which was now incased in a hard shell of lime more than a line in thickness. 
* Duparcque has so multiplied and, I may say, mystified uterine diseases, that it is 
impossible to draw intelligible descriptive lines between his various divisions ; and as 
for exact clinical diagnosis, that is in many cases, utterly in vain, nothing but autopsy 
will determine it. Neither is it very important in practice, for close inquiry, a fine 
touch, an experienced eye, and discriminating judgment will enable a physician to do 
his duty without a particular knowledge of such fine-drawn distinctions. Sharpless on the Pessary. 
11 
In less than a month, the lady desired to have another pessary introduced, as 
ail her long-forgotten pains had returned. I found a prolapsed, shapeless, in- 
durated mass almost immoveably fixed in the lower part of the vagina, A glass 
“ flat” was applied, that restored her in one week to her former health. 
There is a disease very common in our city, in which the uterus is not mate- 
rially affected in its body, nor affords much indication of distemper, but there 
projects from its anterior or posterior surface, and firmly attached to it, 
an enlargement somewhat like half an egg, divided lengthwise. Sometimes 
there are several tumors. These are probably tuberculous masses springing 
from the outer uterine surface, as I have noticed them most frequently in women 
predisposed to such deposits in the lungs. These tumors are sometimes very 
tender, and all the appliances of active practice will fail to remove, entirely, the 
projection or its irritability. In several cases of this kind, where there was a 
slight prolapsus, after sufficient previous treatment, I found a soft pessary 
give no pain; and in a short time, although the tumors were not always 
removed, the tenderness was so materially lessened as to give no more uneasi- 
ness, and the general health became good. I have several times known preg- 
nancy to occur in this variety of disease, and after the maternal enlargement had 
subsided, the original tumor was found about in the same condition as before, 
and requiring the same application to produce ease and good health. I have not 
considered the constant presence of the perforated flat pessary incompatible with 
conception, that condition having occurred several times within my own observ- 
ation, and I have heard others make the same remark. 
I have an unmarried patient at this moment, who had suffered for many months 
with aching pain in her feet and ankles to such a degree that she could hardly 
put her feet to the ground. She also had an irritable uterus, slightly depressed, 
and for which she had worn a pessary ; but it produced so much inflammation 
that it was removed, although she acknowledged that it had relieved the dorsal 
and pedal distress. The latter affliction, however, soon returned with great 
violence, and the instrument was restored at her particular request, with an 
entire relief of the pain in her feet; and, thus far, no vaginal irritation has been 
reproduced. This inconvenience in the lower extremities, I presume, arose 
from pressure on the sacral nerves. 
In anomalous pains of the back, abdomen, and pelvis, and even thorax, that 
are felt only in an upright position, and that do not appear to have a spinal or 
any other tangible origin, the pessary, even where there is no apparent prolapsus, 
will sometimes act like a charm. This may be called imagination in the patient, 
but its good results are too demonstrable to be conceited. 
A constant predisposition to abortion I have known in several instances entirely 
removed by supporting the uterus until quickening: the temporary prolapsus, 
from the increased weight, and the consequent irritation, being thus prevented. 
Confinement for several months would, perhaps, have yielded the same result; 
but to most women, the former is the least disagreeable remedy. 
A pessary used a few days previous to, and during the catamenia, has often 
relieved the great distress of dysmenorrhsea, and has in lime effected a cure. 
Dr. Antony, Georgia, in the reply to Dr. Eve already alluded to, advocates the 
same practice. 
Having now so particularly described cases suited to the pessary, it becomes 12 
Sharpless on the Pessary. 
unnecessary to dwell upon those where its employment would be inadmissible; 
a few directions for its management will indicate sufficiently the circumstances 
improper for its application. 
Under the impression that certain symptoms are always caused by prolapsus, 
and that for this lesion a mechanical support is indispensable, some physicians, 
without investigating the particular causes that may originate the distress, and 
the exact condition of the parts, have introduced a pessary themselves, or given 
it to the patient to use. In every case, even of simple prolapsus, it is absolutely 
necessary that the precise state and position of the organ be learned, in order 
that all irritation may be first removed, and that a suitable pessary may be 
selected ; and then the physician should make the application himself. 
Case.—A respectable practitioner, after a very superficial examination for 
uterine disease, prescribed rest, leeching, &c. When he supposed the parts were 
prepared, he gave the lady several pessaries, of various shapes and sizes, that 
she might select one that she thought would suit her. After many unsuccessful 
attempts either to introduce at all, or retain one without excessive pain, she was 
informed by her attendant that nothing more could be done for her, and that any 
instrument would do her great harm. Upon being called, I found an indurated 
uterus firmly adhering very low in the vagina. All appearance of neck had 
disappeared, and the mouth was patulous with reflected lips. There was some 
tenderness upon hard pressure, and the bearing down pain in the stomach and 
back was excruciating. After a few days’ rest, a small flat pessary was intro- 
duced, but it produced so much suffering that it was replaced in twenty-four 
hours by a small globe. This was in a short time changed for a larger one, 
which effectually relieved the bladder of pressure, and all pain disappeared, 
except during the catamenia, and after great fatigue. An enlargement and ten- 
derness of the abdomen, that had long annoyed her and prevented her fastening 
her clothing was removed, and she feels so well, that I am frequently thanked 
for the relief, and which is almost always accompanied by some observation 
upon the unsuccessfulness of my predecessor. 
To give, in a few words, what I would consider the circumstances properly 
adapted to the use of the pessary, I would say, that it should never be employed 
until perfect relief had been obtained in recumbency, even during a cough or 
sneeze, of all those painful symptoms that were believed to depend upon uterine 
disease : the principle of its operation being only to remove those distresses that 
are produced by an upright posture; and even then the organ must bear lifting on 
the finger, with the patient erect and coughing, without much pain being felt. 
A smaller pessary than it is thought will be required for permanent use, should 
be introduced first; and if there has been previous irritation in the region, rest 
for a few days will allow the cavity to become accustomed to the presence of a 
foreign body, and then whatever change that may be considered necessary in its 
size or shape may be made. 
I will merely remark, in closing, that the pessary has had its ultra-admirers, 
and its uncompromising contemners; and that, like many other remedial agents, 
both friends and enemies have been mistaken in its powers. It can be made of 
great service when correctly applied, and will produce equal injury when used 
without judgment, and I think that no man will discard it from his practice who 
has studied, without prejudice, the effects of its proper application.