Identifier: principlespracti00dudl (find matches)
Title: The Principles and practice of gynecology : for students and practitioners
Year: 1904 (1900s)
Authors: Dudley, E. C. (Emilius Clark), 1850-1928
Subjects: Gynecology
Publisher: Philadelphia : Lea Brothers & Co.
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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y uponthe curves of the pes.sary. The accompanying cuts illustrate the shapeand curve of the Hodge pessary as modified by Emmet and AlbertSmith. Figure 380 represents the curves of Emmet, and Figure 381 TREATMENT OF RETROVERSION AND RETROFLEXION. 667 those of Albert Smith. For convenience, let us characterize that curveNvhicli rests in the posterior vaginal cul-de-sac as the uterine curve,and that which occupies the part of the vagina adjacent to the pubisthe pubic curve. The acuteness and length of the uterine curvedetermine the height to which the pessary will lift the uterus. Thelonger and more acute the curve, the higher the uterus will be lifted,and vice versa. The smaller curve of the Emmet modification willanswer the average indication more nearly than tiie sharper curve ofthe Albert Smith modification, which may lift the uterus too high.The pubic should generally be proportioned to the uterine curve—that is, the greater the uterine, the greater the pubic curve. A Figure 382.
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Schultzes sleigh pessary in position. This pessary is not in general use, but is serviceable tohold up the vesicovaginal wall in cases of cystocele and rectocele. pessary properly adjusted in all other respects may, by pressure uponthe urethra and neck of the bladder, create vesical tenesmus and ure-thral irritation. This calls for increase in the pubic curve—that is,the pessary should be bent away from the irritated part. The pubiccurve may, however, be so great that the lower part of the jiessaryoccupies the centre of the vulva, where it is apt to create irritation.For this condition lessening of the pubic curve is the remedy. Thepessary should not be so wide as to distend the vagina. The lengthshould be measured by the distance from the lower extremity of thesymphysis pubis to the posterior vaginal cul-de-sac, less the thickness 668 D IS PL A CEMENTS. of the finger. If properly adjusted in a suitable case, it should sus-tain the pelvic floor in its normal relations and the uterus

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