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While every case may not require such an examination to perfect a diagnosis, its use should not be forgotten nor neglected, if doubt or uncertainty is present. There are frequently cases, and the ones to which I de- sire to call special attention, in which some of the various forms of displacement are present, which admit of correc- tion by appropriate methods; but, when a rigid pessary is July 3, 1886.] CHASE: MEGHAN IGAL SUPPORT IN UTERINE DISPLACEMENTS. 11 applied to prevent a recurrence, the patient suffers pain, and serious risk of exciting inflammation is invited. Suppose it is a case of retroversion which is easily cor- rected by Elliot's replacer or bimanual palpation, aided by position, and yet the kind of support applied — probably a Smith's retroversion pessary — will not be tolerated, what is to be done ? After gently correcting the malposition, with the patient either in the Sims position or, better still, the knee-chest position, that gravity may more effectually aid the reduc- tion, introduce into Douglas's cul-de-sac one or more pled- gets of cotton moistened with glycerin, to which has been added ons or two per cent, of pure carbolic acid (it being of great importance that the glycerin used be pure, and not the ordinary article of commerce), with a small piece of thread attached to each, so that, if circumstances require, the patient can be instructed to remove them. If properly placed, and giving comfort by overcoming the displacement, they may be allowed to remain two or three days, when the attendant will remove Mail Order Levitra Online them and apply fresh ones. Such a method of elastic support, kept up for a period of a few days or a few weeks, may have been sufficient to effect a cure ; or, if more permanent support is required, it will Mail Order Levitra Online often be found, after pursuing such a course of treatment, that Mail Order Levitra Online an appropriately fitting pessary will be tolerated without the least inconvenience to the patient. If there is some engorge- ment of the uterus, the osmosis excited by the glycerin, as evinced by a free watery discharge from the vagina, will act as Mail Order Levitra Online a powerfully curative agent by depleting local con- gestion and restoring the circulation to a normal condition. In cases where evidence of inflammation and congestion is wanting, a cotton tampon, covered with gutta-percha tis- sue, is light and elastic, and, when properly sealed, as it may be by a little practice from the heat of a match or the flame of a gas jet, is almost or quite impervious to moist- ure, can be applied and allowed to remain for several days without becoming contaminated by the vaginal secretions, and, as in the other Mail Order Levitra Online case, can, if necessary, be removed by the patient by having a silk thread attached. Sometimes, where a condition of hyperesthesia obtains, the use of iodoform, applied with the tampon, exerts a sedative influence, and prepares the way for Mail Order Levitra Online more positive measures of support. The use of cotton tampons, either dry or moist, with or without the gutta-percha covering, as circumstances may indicate, is simply invaluable, being easy of application and attended with little or no risk, and or- dinarily without discomfort to the wearer. Cases present themselves where there is Mail Order Levitra Online marked vaginal relaxation associated with the displacement, in which Mail Order Levitra Online the tampon Mail Order Levitra Online should be moistened with glycero-tannin Mail Order Levitra Online or fluid extract of Pinus canadensis, where the combined alterative and astringent action is attended with results the most sat- isfactory.* The preparatory steps to more positive support in pro- lapsus, to a ring pessary, or occasionally to a stem pessary, * In cases of anteversion, with hypersesthesia of the uterus, the same treatment may be followed, only the cotton tampons should be placed anterior to the cervix and as high as possible. can be accomplished by several pledgets of cotton under and, if required, anteriorly, posteriorly, or laterally to the cervix. If a lacerated and everted cervix or ruptured perinseum is present to Mail Order Levitra Online complicate the situation, the first steps toward a radical cure may consist in its repair. The former, by inducing uterine hypememia, adds to the weight of the uterus and carries it downward, while the latter, by taking away from underneath the normal support of the pelvic organs, brings on prolapsus, anteversion, rec- tocele, and vesical tenesmus, with a train of symptoms and consequences which, in some women, make their life a constant burden and unfit them not only for society, but for the commonest duties of life. Mail Order Levitra Online Here, as in all congested conditions of the uterus and its appendages, the use of vaginal injections of very hot water, taken when the patient is in bed, with the hips elevated and on a bed-pan, should be enjoined. Such apparatus should be used as will exclude the introduction of air and insure the delivery of a constant stream. The use of thorough hot-water douching in overcoming capillary and venous congestion, both of the uterus and of all the pelvic organs, is a matter of the first importance. The full therapeutic effect can only be obtained by insisting that the patient conform strictly to tlie directions for its use. The water should Mail Order Levitra Online be used in considerable quantities — at least several quarts — with the patient in bed, and the hips elevated in such a manner as to distend the vagina in some good degree, and at a temperature as hot as can be borne without burning the patient. Thus used, it will be a most valuable adjuvant in the preparatory treatment for correcting uterine displacements. Should inflammatory conditions of the cer- vix or uterine body be present, they should receive due consideration and appropriate treatment. Another complicating circumstance found in the efforts to overcome uterine displacements is that of chronic pelvic peritoneal and cellular inflammations as embarrassing, if not wholly prohibiting, any direct effort toward their reduction. It is probably no exaggeration to say that the cases of more than one third of the patients with uterine displacement, seeking relief, are more or less complicated with past or present cellulitis or peritonitis, and that a proper apprecia- tion of their presence and consequence is not only a sine