cis, &c., or decoct. querci, vel gallarum, &c. will be found highly serviceable. They may be used three times a day, and in quantity of not less than two or three ounces at a time. The syringes in common use for females are altogether useless, with the exception of that of Clark's. A more simple instrument, and one which I have for several years always recommended to patients, is an elastic gum bag, capable of holding about four ounces, attached to a pewter pipe of four or five inches in length, and of the circumference of a common clyster pipe, the end being slightly bulbed and perforated with four or five small holes.*

Combined with the above tonic plan, the patient must wear a broad bandage over the abdomen. It ought to be tightest at the bottom, in order that the cavity of the pelvis may be relieved as much as possible from the pressure of the intestines. The adjustment of a suitable bandage is of the utmost importance; so much so, that we shall frequently find the best directed efforts fail when this is neglected.

Persevering in these means, there are very few cases of prolapsus, following parturition, which will not be effectually relieved in a short time; if, however, the complaint should continue, we must make use of some mechanical contrivance, in order to support the parts in their natural situation. this important purpose, the pessary hereafter to be described will, perhaps, answer better than any other in use.

For

Seeing, then, that the too early rising after delivery is a frequent cause of the complaint, it is certainly of great importance that the obstetrical practitioner, in every instance where the least predisposition exists in the constitution of his patient, should insist on a stricter and longer confinement than usual, so that the uterus may get reduced to its natural size before much exercise is allowed; by this simple precaution, I am confident, many cases of prolapsus might be prevented.

Secondly. When the disease arises from leucorrhoea, and other weakening discharges, together with a predisposed habit of body, we shall find the complaint, under these circumstances, of all others, most difficult of cure. As these symptoms, generally, arise from or depend on some derangement of the stomach and bowels, or on some deficiency of the secretions, and, most probably, that of the bile; the treatment ought to be commenced with such medicines, diet, and exercise, as will have a tendency to restore the general health of the patient; while, at the same

*These Instruments are sold by Patrick Dickie, Druggist, &c., 443 Broadway.

time, we must be particular to correct the morbid secretions of the parts.

Of the medicines, I have found that alterative doses of mercury, every night, or every other night, and bitters combined with laxatives, in the form of watery infusion, taken twice or three times a day, have produced the best effects; indeed the amendment I have witnessed from a perseverance in these remedies, is truly astonishing, far surpassing any thing which could have been anticipated, or expected from the usual course of bark and wine.

The diet ought to be light and nourishing, adapted to the. state and powers of digestion at the time; for, to burden a debilitated stomach with strong, indigestible food, would only have a tendency to increase its weakness, and thereby aggravate every evil under which the patient laboured. It is more agreeable to sound reason, to let the food consist of such materials, and be in such quantities only, as will sit easy; and should even less be taken than could be digested, instead of retarding, it would promote the recovery of the patient, as the stomach would sooner be restored to a healthy action.

When any part of the body is weakened or relaxed, it appears necessary that the individual should take exercise of some kind, proportioned to the age, situation in life, and peculiar circumstances of the patient. Although rest in a horizontal position has been strictly enjoined in the preceding pages, it is to be understood in reference chiefly to those cases where an inflammatory action exists in the parts; but, when the complaint arises from weakness and relaxation, I am pretty certain that confinement would only have a tendency to increase the disposition to the disease. The patient ought, therefore, to take exercise, proportioned to her age, strength, and state of body; e. g., walking, riding, sailing, or any other kind of exertion which does not fatigue too much, will be proper.

As the discharge from the vagina is, generally, pretty profuse, it will particularly claim our attention. Cold injections, of a solution of some of the metallic salts, or a decoction of oak bark, &c., may be used with very great advantage; for, besides their effect in suppressing the discharge, they have a happy tendency to contract and impart tone to the parts. Cold bathing may, also, upon the same principle, be used, and ought seldom to be omitted, except when the symptoms, or the severity of the weather, render it improper. In the winter season, sponging the back, hips, and thighs, with cold water, or salt and water, may be used as a substitute.

The abdominal bandage is of greater importance in this

species of prolapsus, than in any other; for, as we have already seen that the disease arises from, or depends, in a great measure, on relaxation of the pelvic viscera; therefore, too much care cannot be taken in its application, in order to preserve that cavity from the weight of the organs above.

When the predisposing and exciting causes have been removed, and the discharge, in some measure, corrected; unless an immediate amendment follows, the pessary ought to be used; and, if persevered with, in conjunction with the above means, the majority of cases of prolapsus will be cured, and the rest very materially relieved. .

Thirdly. In those cases which have arisen from too great an afflux of blood to the parts, such as in chronic inflammation of the womb, &c., our first step will be to subdue that action by the use of proper depleting remedies; and here it may be necessary to observe, that when general bleeding is thought inadmissible, leeches, in sufficient number, applied to the ostium vaginæ, will have a most happy effect. After the cause or causes have been removed, the general course of treatment as before pointed out, must be pursued, varying it, however, from time to time, as circumstances require.

Fourthly. When prolapsus is induced from a fall or contusion, &c., particular attention must be paid to the local injury; the same as if it had been received in any other important part of the body; and it is very proliable, that by the time the patient has recovered from the effects of the accident, the prolapsus will be greatly mitigated. Should that not be the case, it will be proper to make use of astringent and other tonic remedies, as before advised, together with a more immediate support of the parts, by the use of the pessary. I would just remark, that prolapsus occasioned by external injury, is much more likely to be permanently cured, than from any other cause.

Lastly. In the treatment of external prolapsus, our attention will naturally be directed, in the first place, to examine the state of the bladder and rectum; and afterwards to the tumour itself, to ascertain whether it is in a fit state for reduction. For, should there be much inflammation, or perhaps ulceration, it would be improper to attempt it, until such disease is somewhat corrected, by the use of proper remedies; such as bleeding, laxatives, fomentations, opiates, &c. If adhesion should have taken place to any extent, between the tumour and the surrounding parts, all attempts to replace the prolapsus would be improper; for, in such a case, we should have to content ourselves with a palliative mode of treatment. But, supposing the prolapsus be in a fit state for reduction, the operation ought imme

diately to be attempted; and, if successful, the womb must be kept in its place with the assistance of a large pessary. The patient should afterwards be confined some days to her bed, or at least until such time as the irritation has ceased; after which, the case may be treated agreeably to the foregoing principles.

The instrument which has been alluded to for supporting a prolapsus of the womb, and the one which I have had the honour to introduce into practice, is of a globular shape. A bag of elastic gum, of a suitable size, is secured perfectly air tight to a tube of ivory and silver; the tube contains a valvular mechanism, capable of retaining such quantity of air as may be introduced into the bag, which is done by means of other tubes and a large elastic bottle; so that the pessary may, with the greatest ease, be either inflated or exhausted after it is introduced into the vagina. By a reference to the plate and explanation, a better idea of its principle may be gathered, than from any other description.

The advantages of a globular pessary have been universally admitted, particularly for protracted cases; but the chief objection to their more general adoption has been, I believe, owing to the pain and difficulty always experienced on their being introduced. This difficulty is now happily obviated; inasmuch as the inflation and exhaustion are always performed while in the vagina; besides, one of large dimensions is just as easily applied as a smaller one. Another, and what will be esteemed a great advantage, over all other instruments for a like purpose, is, that the patient, from a few words of instruction, can learn to introduce and withdraw it herself, and that too without one particle of pain.

It is necessary, in the use of this, and other globular pessaries, to remove them during menstruation; but some advantage would be derived from doing it oftener; say once a week. Thiswould afford an opportunity to make use of astringent injections,. so essentially necessary in restraining the discharge, which oftentimes is troublesome; as well as for the purpose of causing the relaxed parts to contract; so that the size of the instrument might be diminished from time to time, till at last it could be dispensed with altogether.

EXPLANATION OF THE PLATE.

Fig. 1. The pessary,

Fig. 2. A brass tube, (a) screws into the opening of the pessary, as is represented at (h) fig. 5, to push back the valve, fig. 6, for the admission of air into the bag; (b) a stop-cock.

Fig. 3. A bent tube, to be connected with fig. 2 at (c), and fig. 4 at (e); each end fits perfectly air tight.

Fig. 4. The inflating bag, (d) the stop-cock, (e) to receive the end of fig. 3.

Fig. 5. A section of the pessary tube. It is about 1-2 an inch in diameter, and 1-2 long; the silver end (f) screws on to the ivory tube (g) at (m); (h) the opening to receive the end (a) of fig. 2; (i) is intended to represent a thin layer of cork within the silver end or cap: the valve acting against it, renders the instrument completely air tight; (k) shows the bore of the tube, which is about 1-4 of an inch in diameter-it contains the valve and spring; (4) represents the opposite end, with several small perforations in it.

Fig. 6. The valve, which is made of ivory.
Fig. 7. The spiral spring, of silver wire.

Directions for its Application.

Take the brass tube, fig. 2, and screw it into the pessary, to open the valve; then expel the air by grasping the bag, and if the stop be turned, the bag will remain flaccid. In this state, the instrument is to be introduced into the vagina; when this is done, re-turn the stop, and connect the inflating bag to the tube already in the pessary, by means of the bent one, fig. 3. The pessary can now be easily inflated by grasping the large bag, and while in the act of doing so, before the hand is removed, turn the stop of fig. 2, to prevent the escape of the air. The tubes, then, may be separately taken away, and the pessary will be left behind filled with air. To withdraw it, the tube may be applied, as before, to push back the valve, and this is generally sufficient to allow of the instrument's being easily withdrawn ; but, should any difficulty arise, the inflating bag may be connected, having the air previously expelled, and in a moment the pessary will be exhausted, when its removal can, without pain, be accomplished.

ART. IV.-Observations on Emetics.

M. D., of New-York.

By H. T. JUDson,

In the animal economy, the stomach is an organ of the first importance. Those functions by which man is enabled to preserve his individual existence, are commenced in this viscus,