The usual treatment for prolapsus consists almost exclusively in the application of supporters of various kinds. The amount of ingenuity which has been displayed in the construction of devices of various sorts for the purpose of restoring a prolapsed uterus to its natural condition is not surpassed by the display of inventive genius in any other direction. While pessaries or supporters of some kind are often very useful in the treatment of prolapsus as temporary palliatives, and as a means of relieving cases which are incurable, they should ever be regarded as incapable of producing a radical cure. In many cases they actually increase the morbid conditions upon which the prolapsus depends, although giving temporary relief to the most unpleasant symptoms attending this form of displacement.

A rational plan of treatment for prolapsus requires, first, the removal of the causes by which the difficulty has been produced, when they are still in operation; second, relief of the congestion and enlargement of the organ by proper treatment; third, palliation of the painful symptoms attending this condition; fourth, restoration of the natural supports of the organ to a healthy condition.

The first indication must be met by thorough and careful attention to the laws of sexual hygiene. The second indication is best met by a persistent use of sitz baths and the vaginal douche, which should be taken as recommended for the treatment of catarrh and congestion of the womb. In many cases, the douche can bo taken twice a day with advantage, in the morning and again just before retiring at night Greater benefit is derived from this treatment when the patient can remain in a recumbent position for some hours afterward.

In some cases the patient requires rest from walking and other exercises upon the feet. In the majority of cases, however, it is better for the patient to continue as much exercise as can be endured without excessive fatigue, as it is important that the muscular strength should be kept up. The third indication is in part met by the treatment already described. The hot douche and sitz baths will generally accomplish more, than any other two remedies in relieving the local pain and discomfort In many cases, much additional benefit may be derived from wearing a properly adapted pessary or supporter. When the womb is prolapsed, its circulation is interfered with so that the organ becomes engorged with blood. This can be overcome by a restoration of the organ to its proper position so as to give freedom to the circulation. The simplest form of supporter is a small roll of cotton. It should be pressed up against the mouth of the womb after it has been restored to its proper position. It should be introduced while the patient is lying upon the back. The ball of cotton should be large enough to be retained in position, and should be saturated with glycerine or a weak solution of tannin in glycerine before being applied. A string should be tied around the center of the roll to facilitate its removal This application the patient can make for herself, though not nearly so well as it can be made by a physician. Care should be taken in removing the cotton that the organ is not dragged down with it. It should be first loosened by the finger to facilitate its removal. Cases which need the application of the pessary require the care and attention of an intelligent physician.

The fourth indication is the most important of all, as it relates more directly to the radical cure of this affection. Unfortunately, this part of the treatment of prolapsus is rarely attended to. Either the physician fails to appreciate the importance of this part of the work, or the patient is satisfied with a mere amelioration of her symptoms, and fails to persevere in carrying out the proper methods of treatment until a complete cure is effected. In meeting this indication, one of the best of all measures of treatment is the daily employment of special exercises. General exercise is essential for the purpose of strengthening the general muscles of the body; but there are certain special exercises which may be taken, the advantage of which can hardly be overestimated.

We will describe two or three of the more simple forms of special exercise. Let the patient place herself upon a smooth and moderately hard surface. A soft, springy bed is not suitable for the purpose. A hard sofa will answer very well. The feet should be drawn up as close to the body as possible. Let the patient now lift the lower part of the body so that the hips and lower portion of the trunk will not touch the surface, the body being wholly supported by the feet and shoulders. The body should be held steadily in this position for a minute or two, or as long as possible without any considerable fatigue to the muscles, when the body should be lowered to its original position. After a few minutes' rest, the same exercise should be repeated. This exercise may be continued twenty or thirty minutes, according to the patient's strength. By elevation of the hips in the manner described, the contents of the lower portion of the abdomen will, by the force of gravitation, be drawn from their abnormal position into their original place. Prompt relief very often follows the employment of this measure, even the very first time it is applied; and if it is continued daily, and two or three times a day when the patient is sufficiently strong, very excellent results may bo looked for.

Another movement which is very effective for the same purpose, consists in supporting the body upon the toes and elbows with the face downward, the hips being raised as much as possible. Still more thorough exercises may be taken by the aid of an assistant. One of the best of this sort consists in elevation of the lower extremities by means of an assistant, while the patient lies upon the face, supporting the body by the chest and keeping the limbs rigid while the feet are elevated by the assistant. While the hips are elevated in movements of this sort, the intestines fall forward in the abdominal cavity, dragging the prolapsed womb after them. Movements of this sort not only strengthen the abdominal muscles by calling them into active exercise, which of itself has a tendency to lift the prolapsed organs into position, but the force of gravitation acts directly to restore the displaced organ to its normal position. The patient will also derive great advantage from sleeping with the hips elevated as much as is consistent with comfort. In addition to these measures, the patient may take with advantage certain exercises for developing the muscles of the trunk and abdomen, such as bending forward and backward, bending sideways, kneading and percussing the abdominal walls, lifting weights with hands stretched above the head while laying down, etc.

Electricity is an admirable remedy for use in these cases. It may be applied both externally and internally. When applied internally, it should be. in the hands of a competent physician unless administered in connection with the hot douche, a plan which we very highly recommend. These movements may be taken several times a day with advantage. If taken but once, the best time is at night just before retiring. This is also the best time for taking an astringent douche. A very excellent plan is to take the movements first, then the hot douche, concluding by the injection of a pint of water containing one quarter of an ounce of alum or tannin, or two tablespoonfuls of a strong decoction of oak bark. By means of the movements the uterus is restored to its natural position, and by the aid of the hot and astringent injections, the lower supports of the uterus are toned up so as to aid in holding the organ into position.

Congestion is also relieved by the same treatment; and this gives nature the opportunity during the night to do much toward restoring the organ to its normal condition. When the patient suffers much with constipation, which is always present in these cases, and very obstinate, the bowels should if possible be relieved at night just before retiring. In case there is loss of desire to move the bowels, which sometimes exists, benefit will be derived from the injection into the rectum of four tablespoonfuls of cold water containing five or six drops of tincture of camphor. The solution should be retained ten minutes, by the end of which time there is generally a very strong desire to move the bowels.

In cases in which the prolapsus is due to rupture of the perinaeum in childbirth, a surgical operation may be required to effect a cure. We have met a number of cases of this kind, and by performing the necessary operation to restore the parts to a natural condition, have obtained the most gratifying results. It has been suggested to secure support for the prolapsed organ by means of various operations upon the vaginal walls. Operations of this sort are seldom required. In cases in which the organ is prolapsed to such an extent as to appear outside of the body, which is a very rare condition, however, a complete cure can rarely be effected, although the organ may be supported by means of properly adapted pessaries.