Sometimes when the corpus has been firmly bound back by peritoneal adhesions they may be broken up by very forcible conjoined manipulation under ether, but the operation is dangerous, and should therefore be {173} undertaken only by an expert operator. In place of this operation Lawson Tait has proposed to open the abdomen, break the adhesions, and stitch the fundus uteri to the abdominal wound. This operation in the hands of such an operator as Tait is probably not more dangerous than breaking up firm adhesions by forcible conjoined manipulation. [Illustration: FIG. 19. Schultze's Sleigh Pessary in place, as adjusted for prolapse, retroversion, or retroflexion with great relaxation of the vaginal walls (after Schultze).] In certain cases in which replacement is impracticable or impossible on account of inflammation or adhesions a soft rubber ring may be inserted, and will often give decided relief by lifting the uterus and pelvic floor nearer to the health level. In the treatment of all displacements coition should be forbidden or permitted only with great moderation, and the pessary should be kept clean by copious daily applications of the vaginal douche. Every three or four weeks the instrument should be removed and the pelvic organs carefully examined. It should be urged that no man can safely apply the pessary until he has fully appreciated its indications and contraindications. Few practitioners possess naturally the mechanical skill necessary to its proper adjustment. Of this thousands of unfortunate women bear witness. Its dangers in inefficient hands are in striking contrast with its usefulness when judiciously employed. Many cases of displacement, both anterior and posterior, are so complicated by prolapsed and adherent ovaries, by advanced disease of the ovaries and Fallopian tubes, and by peritoneal adhesions, that not only {174} replacement, but even palliation, is impossible; then, as a final resort, the activity of the pelvic organs, both physiologically and pathologically, may be put at rest by the removal of the ovaries and Fallopian tubes. [Illustration: FIG. 20. Front View of Schultze's Figure-of-Eight Pessary. The upper opening is intended to hold the cervix. This pessary has the uterine and pubic curves, as in Figs. 7 and 8.] [Illustration: FIG. 21. Thomas's Retroflexion Pessary.] William Alexander of Liverpool has devised an ingenious operation of shortening the round ligaments for the radical cure of descent and of the posterior displacements. He reports twenty-two cases of the operation in his own practice and several more in the practice of other surgeons, with almost uniform success in completely curing the displacements. The operation, although new, gives promise of a brilliant and successful future. Lateral Versions and Flexions.