Compliments of the Anther. 
THE FTTH OF THE DRIED CORN-STALK AS A 
UTERINE TENT; 
AND 
GENERAL REMARKS UPON THE USE OF UTERINE TENTS IN 
GYNECOLOGICAL PRACTICE, WITH CASES. 
BY W. T. GOLDSMITH, M. D.. ATLANTA. 
REPRINT FROM THE TRANSACTIONS OF THE MEDICAL 
ASSOCIATION OF GEORGIA 
Jas. P. Harrison & Co., Printers, 
Atlanta, Ga. THE PITH OF THE DRIED CORN-STALK AS A 
UTERINE TENT; 
AND 
GENERAL REMARKS UPON THE USE OF UTERINE TENTS IN 
GYNAECOLOGICAL PRACTICE, WITH CASES.* 
W. T. GOLDSMITH, M. D., ATLANTA. 
Uterine tents are most valuable agents in the hands of 
the gynaecologist. They have a two-fold value, as diagnos- 
tic and therapeutic instruments ; and so deserving are they 
in these respects that their usefulness has been fully recog- 
nized wherever the treatment of the diseases of women 
has attained anything approaching scientific importance. 
Uterine tents were not unknown to the ancients. Aetius, 
referring to the causes of sterility, assigns one of these to 
contraction of the os uteri, and points out the use of com- - 
pressed sponge as a remedial means. Sir J. Y. Simpson, in 
his lectures, speaking of the supposed discovery of Dr. 
McIntosh in dilating the os and cervix, remarks: “Dr. 
McIntosh, a medical teacher of great reputation in this 
school some twenty-five years ago, thought he was the first 
to call attention to this particular (obstructive) form of 
dysmenorrhoea, and proposed to treat it in the same manner 
as surgeons do strictures of the urethra.” * * * “ The plans 
of treatment then recommended by Dr. McIntosh was fore- 
* A few typical only, are given. 2 
stalled ages before. For, in works included among the 
Hippocratic writings, the disease is most distinctly spoken 
of, and the appropriate treatment described. In the 13th 
section of the F'uvatxstwv llpwrov the treatment of these 
cases is given where sterility is due to some unusual condi- 
tions of the os uteri ; and among other things, the writer 
tells us that where the orifice is very much contracted, it 
must be opened up with bougies and leaden instruments. 
So that this plan of treatment is at least 2,500 years old. 
Some others, among the older Greek and Roman writers on 
female diseases, have also alluded to this form of dysmen- 
orrhoea or sterility, and to its treatment by dilatation of the 
os uteri, though none so distinctly as the Father of medi- 
cine himself. But there are various surgical works of later 
date in which mention is made of this matter in the most 
explicit terms. Thus, in the Marrow of Chirurgery, pub- 
lished in the latter part of the seventeenth century by Mr. 
Cook, of Warwick, a work containing many curious notices 
and cases in obstetric, medical and surgical practice, this 
author treats in one of his chapters of closure of the “ inner 
orifice ” of the womb, or os uteri, and recommends it to be 
enlarged when necessary by gentian root, prepared sponge 
and afterwards by the introduction of hollow instruments 
of silver, ivory or horn, and these means, he adds, are better 
than incision.” 
Uterine tents have been made of many different sub- 
stances. Ivory has been thus employed from which the 
boney matter was abstracted by hydrochloric acid. Dr. 
McIntosh and others used metallic bougies of graduated 
sizes for the successive dilatation of the cervical canal. Dr. 
Priestly employed expanding forceps the size of the ordin- 
ary uterine probe. Cotton, tow, wool, cloth, india-rubber, 
roots of various plants, have been advocated and used. The 3 
most commonly employed substances are the compressed 
sponge and laminaria digitata or sea-tangle. 
Dr. J. A. McFerran, of Philadelphia, Pa., endeavoring to 
avoid the dangerous consequences often attending the use of 
the sponge tent, employs the following, which may be in- 
serted here, among the varieties of tents : He fixes a sponge 
tent upon the extremity of a metallic or hard-rubber tube, 
which he envelopes, by a close-fitting piece of thin rubber. 
Fluids reach the tent, from the vagina, through the tube. 
The sponge is dilated, while the mucus membrane is pro- 
tected by the rubber. 
Among the inventors of uterine tents, our State has 
already furnished two. My friend, Dr. Y. H. Taliaferro, of 
this city, a few years since (1871), published his discovery of 
the cloth tent. Dr. Taliaferro’s tent is well known. Some 
Western physician, whose name I do not now remember, 
claims to have improved Dr. Taliaferro’s tent, by the use of 
bonnet wire, around a bent strand of which he rolls the 
cloth. By this improvement, he claims to secure greater 
rigidity, and increased facility of introduction, without im- 
pairing the usefulness of the tent. Another Georgian, Dr. 
G. E. Sussdorf, formerly of Macon, now of Hew York city, 
has, within the past year, published a description of a tent, 
which he manufactures, from the root of the tupelo tree. 
The expansive power of the compressed tupelo root, he 
asserts, is considerable. This root is, however, rather diffi- 
cult of procurement, and, before it can be used as a dilator, 
must be subjected to compression, by instruments, not al- 
ways conveniently at hand. 
I have the pleasure of bringing before the profession a 
new candidate for their consideration, as a uterine tent. It 
is the pith of the dried cornstalk. It may, or may not, have 
advantages over other materials, manufactured into tents. 4 
I will permit the profession to determine this matter. To 
my mind, there are many points of superiority. These 
points will be developed, as I proceed with the reading of 
this paper. I will, however, pause long enough to show the 
ease and rapidity with which they can be made. You take 
a joint of the dried stalk ; strip it of its cuticle, and com- 
press the pith, slowly and firmly, between the thumb and 
index finger. You see how compression, made in this way, 
diminishes its bulk. By continued pressure, you easily re- 
duce it to four or five times less its original size. You can 
compress it to any intermediate size; or, it may be used 
without compression, to carry medicaments to the interior 
of the uterus. Because of its ready compression, to any 
desired bulk, you have the tent entirely under your control. 
Slight compression will give you moderate dilating power. 
Compress it as much as possible, and you can get a dilating 
power equal to the sea-tangle, or sponge. You may com- 
press the pith first, and afterwards, with a sharp knife, trim 
to the desired length and size; or, you may first cut the 
pith, to the size you wish it to dilate, and then compress it for 
easy introduction. Any curve may be given the tent, by 
selecting a piece of pith that has been curved in its growth. 
The pith absorbs fluids readily, and, when compressed, ex- 
pands, by such absorption, to its original size. 
The wood-cut shows the degree of compression to which 
the pith may be subjected. Fig. 1, shows a piece of pith 
(with string passed through it, by means of a needle,) cut to 
the size, to which the cervical canal in a given case, may be 
desired to be dilated. Compressed by the thumbs and 
fingers, it is reduced to the size of fig. 2. The cut represents 
the actual size and preparation of a tent. To reduce fig. 1 to 
fig. 2, required one minute and a half, by the watch. After 
introduction into the cervical canal, fig. 2 will expand to the 5 
size of fig. 1. More rapid expansion may be bad by prick- 
ing the surface of the compressed tent, or by forming a 
canal through the tent, by first inserting a wire through the 
lenglith of the pith, before compressing it. 
*V-' F/ff.2 
As before stated, uterine tents have two important uses— 
for diagnostic and therapeutic purposes. Tents are employed 
for dilating the entrances to the cavity of the uterus, that 
the finger, as well as the eye, of the gynaecologist may de- 
termine the pathological disturbances of the interior of that 
organ. When symptoms point to the existence of intra- 
uterine polypi, dilatation by tents afford the utmost satisfac- 
tion in clearing up the diagnosis. In speaking of determin- 
ing the presence of intra-uterine tumors, Sir J. Y. Simpson 
remarks; “ Many years ago, I saw, with my friend, Dr. Al- 
exander Wood, a patient who died of menorrhagia, and in 6 
whom, after death, we found a polypus which was in process 
of being eliminated by the uterus ; and it was here so mani- 
fest that the patient’s life would have been saved if only we 
could have got into the interior of the uterus so as to recog- 
nize and remove the cause of all the mischief, that I began 
to think more earnestly whether it might not be possible to 
do so in any similar case.” In this way he was led to use 
the sponge tent for the first time in exploring the cavity of 
the womb. 
On this subject, Dr. Marion Sims, referring to a case, 
remarks : “ This case strongly illustrates the present import- 
ant method of exploration; for here we could not have de- 
termined the cause of the uterine enlargement but by pass- 
ing the linger into the cavity of the organ after dilatation 
of the cervix. Indeed, before the use of sponge tents, we 
could not by any possibility have diagnosed such a case as 
this. But now we determine with the minutest accuracy, 
not only the presence, but the size, position, relations and 
attachments of all such tumors.” 
Sir J. Y. Simpson, among other varieties of cancer of the 
uterus, in his lectures, gives a description, with drawings, of 
general cancerous ulceration, (which he declares to be the 
most common form of the disease of the interior of the 
uterus.) assailing the mucous membrane, ending in fatal rup- 
ture of the fundus, or assuming “ the form of a sessile irreg- 
ular excresence or fungus mass, projecting into and distend- 
ing the uterine cavity, or even dilating and partially press- 
ing through the healthy but distended os uteri.” Illustra- 
tive of this variety of cancer, he gives the following case, 
and the means employed of ascertaining a correct diagnosis: 
He says: “ The first time I ever saw and fairly made out 
the case of this last and most common form, was in a patient 
who had long suffered from an abundant serous and some- 7 
times offensive discharge. She was here, from England, 
under the care of an old master of mine, and had often 
been treated by the application of caustics to the vagina and 
cervix, with the hope of arresting the copious and constant 
discharge. When consulted in regard to her case, I sug- 
gested the introduction of a sponge-tent into the os uteri, 
that wTe might then have an opportunity of making out more 
clearly the source of the discharge, or, at least, of making 
sure whether it might not be proceeding from the uterine 
cavity instead of the vaginal walls. After the sponge had 
been introduced the discharge was found to be checked, for 
the first time for many months, and on its withdrawal, a 
fungating mass was discovered by the finger in the interior 
of the uterus. You must not hold, therefore, that a patient 
has not got a cancer in the womb because the cervix is 
healthy ; for the cervix may remain quite sound when the 
body of the organ has become extensively diseased.” 
The tent becomes of great use sometimes, in determining 
the existence of a vesico-uterine fistula wdien a vesico- 
vaginal fistula may be suspected. The same authority says : 
“ In vesico-uterine fistulae, in order to discover the perfora- 
tion, you will generally require to plug the os uteri with a 
sponge tent. The use of the tent aids the diagnosis in two 
ways. First, by its pressure it prevents the escape of the 
urine per vaginam, thus proving the communication with 
the bladder to be placed higher than the os uteri. And, 
secondly, the due expansion of the os and cervix uteri, with 
tents, will enable you to reach the fistula with your finger or 
a sound, so as to empower you to trace the intercommuni- 
cation between the urinary and uterine cavity.” 
The employment of tents affords the gynaecologist a ther- 
apeutical means of the greatest value in many diseases and 
conditions of the uterus. The power of the sponge tent to 8 
destroy polypoid growths is now well-known. Dr. Sims, in 
his work on Uterine Surgery, claims—innocently, no doubt— 
the credit of originating the removal of tumors from the 
uterus by pressure from tents. Simpson has, however, 
precedence in this treatment. Dr. Sims had accidentally 
allowed a tent to remain in the uterus of a woman having a 
polypoid growth for eight days. His attention being called 
to the oversight, he removed it. Describing this case, he 
says : “ When the tent was introduced a week before, the 
tumor was accurately measured, its volume, density and 
attachments all definitely settled, and easily so. 
My surprise may he imagined when, on introducing the fin- 
ger into the cavity of the uterus, after the removal of the 
tent, there was not a vestige of the tumor to be found.” 
Simpson, antedating this, had in his lectures said ; “ You 
must have understood, from what I have already told you, 
that, in a very large proportion of cases of polypus uteri— 
in all those cases, in fact, in which the polypus has not come 
fairly within our reach down into the vaginal cavity—a certain 
diagnosis of the case can only be made out after dilatation of 
the cervix uteri. If access to the root of the mischief be 
needed for satisfactory diagnosis, it is all the more necessary 
for surgical treatment; and what I wish you to understand 
at present is, that, in many cases where you are uncertain 
whether you have to do with an intra-uterine fibroid or a 
cervical mucous polypus, you can, by the introduction of a 
sponge tent, not only open up the way for an unmistakable 
recognition of the true nature of the mischief, but, at the 
same time, in the case of the soft cervical polypus, you crush 
and kill the growth by means of the expanding tent, and so 
rid the patient at once of her disease.” 
Dr. Sims affirms that “ the tent may always be trusted to 9 
destroy fungoid growths and small mucous or nabothian poly- 
pi when they cannot be otherwise removed.” 
He also remarks : “ The power of the sponge tent to mod- 
ify the uterine surfaces with which it lies in contact is truly 
wonderful. It dilates the neck of the womb ; it softens it 
by pressure and by a sort of serous depletion; it reduces 
the size, not only of the neck, but of the body, of a moder- 
ately hypertrophied uterus; it destroys, not only fungoid 
granulations, but even large mucous polypi, and, in one in- 
stance, I saw a sponge tent destroy wholly a fibrous polypus 
as large as a pigeon’s egg.” 
How, while the idea of pressure for the removal of these 
conditions originated with Simpson, Sims has given force 
and authority to the practice. Pressure, as a means of ef- 
fecting changes in the tissue of the uterus by other mechan- 
ical means than the tent has been employed. 
To Dr. Sims is due the credit of using the tent as a 
stimulant to the diseased mucous membrane of the cervix 
and cavity when fungoid granulations are present. The 
tent can be used either medicated or without medication. 
Speaking of fungoid granulations, Dr. Sims remarks : “ The 
curette is simply the adjuvant to the tent, and always to be 
preceded by it. But there are cases where their relation- 
ship is changed, the sponge becoming the adjuvant of the 
curette, and this is when the fungoid granulations are at the 
fundus uteri. Then the sponge is to dilate the cervix for 
the more easy application of the curette.” “ In cases of 
menorrhagia that resisted all treatment, Recamier passed his 
curette into the uterine cavity and raked it out as thoroughly 
as possible. This was before the days of sponge tents. But 
now we first dilate the cervix, pass the finger into the cav- 
ity, ascertain precisely the seat of the fungoid growths, pass 10 
the curette by the side of the finger, and thus operate more 
understanding^.” 
In many cases of menorrhagia, tents employed as tam- 
pons, or for dilating the cervix, to more readily reach the 
seat of the trouble, by suitable remedial agents, become 
important factors in the treatment. The following case will 
be given : 
Case I.—Mrs. T., aged forty ; married ; has had no chil- 
dren. She has suffered from menorrhagia, for twelve or 
fifteen years. At various times, she has, from excessive 
hemorrhages, been brought to the brink of the grave. I 
was called to see her, during one of these severe losses of 
blood. For twelve months, the hemorrhage had increased, 
month after month, with each occurrence of the catamenial 
flow. She had exhausted every means at her command, and 
had passed through the hands of several physicians, with only 
temporary relief. I found her too feeble to assume the 
erect posture—with weak pulse and blanched skin. She 
had been confined to her bed for several weeks. Upon 
examination, the uterus was found to be heavy, cervix 
large, with patulous os. The sound passed into the uterine 
cavity, easily. The organ was slightly retroverted, and pro- 
lapsed. The blood flowed freely, filling the speculum rap- 
idly. Removing the probe, the bleeding was arrested, by a 
temporary packing of cotton. After a few minutes, re- 
moving the packing, the os was brought in view. While 
waiting for the arrest of the flow, a corn-stalk tent, of large 
size, was trimmed, without being compressed, and, upon re- 
moving the cotton, carried into the uterine cavity. Pledgets 
of cotton, moistened with glycerine, Avere packed around 
the os, to prevent the escape of the tent. Twenty-four 
hours afterwards, the cotton packing and tent were removed. 
There had been no pain, of consequence, and no hemorrhage. 11 
A second corn-stalk tent, compressed, in order to dilate the 
canal, was introduced, and retained by cotton, as before. 
The day following, the cotton and tent were taken away, 
and the canal found to be dilated the size of the little 
finger. A pledget of cotton, wrapped on a whalebone 
probe, soaked in concentrated nitric acid, was carried into, 
and swept around the cavity of, the uterus. The patient was 
left with the usual cotton packing. No hemorrhage, of 
consequence, occurred after this. The acid was applied, at 
intervals of a few days, on several subsequent occasions. 
She was placed upon tonics, and liberal supplies of food 
allowed. In a few weeks she had recovered sufficiently to 
attend to her domestic duties, and is now a hale, hearty 
woman, four years after the treatment. 
For the cure of hypertrophy Dr. Sims reports Dr. Emmet 
as saying “ that he has succeeded in doing more for general 
hypertrophy of the uterus by this means in a week than 
could be accomplished by any and all means in two or three 
months.” 
In obstructive dysmenorrhoea from fibroids, relief is had 
by dilating the cervical canal by tents. Dysmenorrhoea is 
often caused by a contraction of the cervical canal, at 
either the os internum or externum. The contraction ocr 
curs most commonly at the os externum. For the cure of 
dysmenorrhoea arising from either of these “ mechanical 
anomalies ” some method of dilatation must be employed, 
an operation undertaken or some kind of (vaginal or stem) 
pessary used. Authorities are arrayed on either side of 
dilatation by inscisions or of mechanical expansion of the 
strictured portions. When the contraction is found at the 
os externum, the bilateral operation will give satisfactory 
results in a large majority of cases. Much, however, can 
be accomplished in giving temporary relief, in these cases, 12 
by the use of tents. The relief is seldom permanent. 
From this fact many gynaecologists condemn the use 
of tents, and either dilate by metallic bougies, force- 
ably and rapidly, or resort to the bilateral operation. 
Forcible and rapid dilatation by metallic bougies, or 
expanding instruments, is too dangerous to secure gen- 
eral approbation. The bilateral operation is not always suc- 
cessful. Dr. Robert Barnes, an advocate of the operation, 
remarks : “ The wished for result is not always immediate. 
In a certain number of cases, indeed, the next ensuing 
menstruation is perfectly easy and future immunity is 
attained. But not unfrequently, the first period or two 
after the operation are even more painful than before.” * * * 
“ Another objection specially urged by the advocates of 
dilatation by tents is, that the opening made by inscisions 
frequently contracts again, whereupon the object of the 
operation is frustrated. This contraction does sometimes 
take place. When it does, it is desirable to repeat the 
operation and to obviate the tendency to contraction by 
wearing a Wright’s intra-uterine pessary for a day or two 
during the healing of the wound.” Tims a stem-pessary 
becomes necessary. In these cases the use of the non-com- 
pressed corn-stalk tent, as a temporary intra-uterine pessary, 
occasionally inserted, will serve as good a purpose. It is 
light and non-irritating. 
When the contraction occurs at the os internum, no care- 
ful surgeon would use the knife, or metrotome double or 
single. Forcible and rapid dilatation being too hazardous, 
dilatation must be accomplished by tents; and while no last- 
ing results may be attained, yet the patient receives great 
temporary relief, and the uterus is prepared for intra- 
uterine support. These pessaries are the more demanded 
because the so-called contraction of the internal os is 13 
the result, more frequently than otherwise, of versions or 
flexions of the organ. When retroversions or flexions ex- 
ist, vaginal, instead of intra-uterine pessaries, will, in many 
cases, correct the trouble and permanently relieve the pa- 
tient. Vaginal pessaries will not correct all cases of retro- 
versions or flexions; and vaginal support will not often 
avail in anteversions or flexions. These conditions often 
demand intra-uterine support for their rectification and cure. 
Tents, in these cases, are to be used not so much to expand 
any portion of the canal as to bring the uterine axis in its 
normal direction, and accustom the membrane and the organ 
to the presence of a foreign substance, that they may ulti- 
mately tolerate the permanent stem pessary. In these cases 
the sponge or the sea-tangle tents could not be employed. 
Moreover, in versions and flexions, besides the dysmenor- 
rhoea, the mucous membrane will be usually found in a state 
of chronic inflammation, and the medicated tent of non 
compressed corn-stalk will be found a remedial measure of 
the greatest advantage. Illustrative of the use of tents in 
dysmenorrhoea, the following cases are given : 
Case II.—Mrs, S., widow, aged thirty-seven years, one 
child fifteen years old, has suffered for many years with 
irregular and diminished flow, with great pain at menstrual 
periods. The pain has been, of late years, so great as to force 
her to bed, and has demanded powerful narcotics for relief 
at each period. She has been treated by several physicians 
for relief of pain, but no local treatment was ever attempted. 
She had almost despaired of relief. I was asked to take her 
case in hand. Upon examination, by touch, the womb was 
found a little tender to pressure and slightly flexed back- 
ward. The speculum revealed a very small os, with a con- 
ical cervix. The probe passed with some difficulty and 
gave considerable pain. A moderately compressed corn- 14 
stalk tent was prepared. It was made small and about one 
and one-half inches in length, so as merely to pass through 
the internal os, and that the larger extremity of the tent 
might be carried within the grasp of the external os. Pledg- 
ets of cotton, moistened with glycerine, were packed around 
the os. This treatment was had six days after the last men- 
strual period. It was followed up, at intervals of from four to 
six days, to within a few days of the next menstrual period. 
The tents were gradually increased in size, but not in 
length, and were permitted to remain eight to twelve or fif- 
teen hours, as they could be well borne. She was instructed, 
upon the appearance of pain, to withdraw the cotton (by the 
attached strings) and the tent. The patient (or nurse) re- 
moved all the tents. Cotton pessaries (tampons), moistened 
with glycerine were to be worn daily during intervals of 
treatment. At the next menstrual period, the flow was 
almost natural in quantity, and, after the first few hours, 
free from pain. The treatment was followed up in the same 
way one month longer. The relief was so great that the 
patient asserted she had never been so free of pain during 
her menstrual life. It was so great she declined further 
treatment, though urged to submit to bilateral incision of 
the cervix for a permanent cure. Three years have passed. 
She still feels the benefit of the treatment, and, while not 
well, asserts, because of the relief given, that she is cured. 
Case III.—Dysmenorrhoea, cervical endometritis, with 
retroversion, Mrs. A, aged twenty-four; married five years ; 
childless ; thinks she miscarried (?) three years ago. Has suf- 
fered with dysmenorrhoea for several years, which has greatly 
increased in the last few years. I was called to see her two 
weeks before an expected period. She had lost flesh ; had 
indigestion, and was constipated ; complained of aching in 
the back, and troubled at times with dysuria; had more or 15 
less leucorrhoea during inter-menstral periods. To the touch a 
velvety condition of the os was discovered,and the organ found 
retro verted. The probe passed with difficulty at the internal 
os, giving considerable pain, with slight oozing of blood. 
The os was small, and lips red from loss of epithelium, with 
a tenacious mucous discharge from the cervical canal. A 
corn-stalk tent, small, moderately compressed, curved, and 
one and a half inches in length, was introduced. Its intro- 
duction caused pain, but by gentle and steady pressure it was 
carried through the internal os. She was told to allow the 
tent to remain as long as it could be borne without great 
pain. I called on the lady eight hours after its introduc- 
tion, and found her suffering considerable pain. She had 
determined to bear more than I was willing she should. 
She believed a speedy cure depended upon “ opening the 
womb.” I removed the tent, administered an anodyne, and 
recommended rest for a few days. During this time she 
was to use large quantities of hot water several times a day, 
and after washing, to throw up the vagina one syringe-full 
of solution of chlorate potassium, and retain it for some time. 
A prescription was also given for the indigestion and con- 
stipated bowels. A fewT days after the cessation of pain, 
another tent, with a little more compression, was used. It 
was removed in a few hours, and the treatment, as above, 
continued. At the next treatment the tent was compressed 
but slightly ; was saturated with tinctrue of iodine and retain- 
ed twelve or fifteen hours. Stopping only for the menstrual 
periods to pass, tents, at suitable intervals, of increased size 
and degrees of compression, sometimes medicated, were in- 
introduced. The probe passed without pain. Cotton pes- 
saries were worn, so that, after the lapse of a few months, 
fill tenderness being removed, a Fitch improved (Hodge- 16 
Smith) pessary was adjusted, and the patient relieved of all 
trouble. 
Tents of the proper length and size, either with medi- 
cated liquids or free of liquids, are of great service in the 
treatment of chronic cervical endometritis. Dr. Thomas, in 
giving his treatment of the disease, says : “ The efforts of 
the practitioner should be directed to producing an alterative 
influence upon a mucous membrane, which is in a condition 
of chronic inflammation, and the avoidance of all influences, 
which may cause it to spread to adjacent tissues. These ends 
will be best accomplished by the following means ; General 
regimen ; emolient applications ; alterative applications ; ob- 
lation or destruction of diseased glands.” He does not include 
the use of the tent in the catalogue of alterative applica- 
tions, but recommends them alone, for dilating the contracted 
external os. Simpson, Barnes and Sims, are all silent on the 
subject. I have been in the habit, for many years, of giving 
the necessary alterative action to the diseased mucous mem- 
brane by the use of the corn-stalk tent. It may be slightly 
compressed, or not at all. If only moderate stimulation is 
desired, it is introduced with a few drops of glycerine, 
rubbed on it. If destruction of the glands is wished, the 
tent can be saturated with any desired solution, and intro- 
duced, where it may be allowed to remain for a few minntes, 
several hours, or even for a few days. The only approach 
Dr. Thomas makes to this method of treatment is, that re- 
commended by Dr. Sims, which consists of depositing a 
small roll of cotton, medicated, in the cervical canal. 
In treating chronic endometritis these authors are silent 
upon the employment of tents other than as dilators. Dr. 
Sims alludes to dilating the internal os by sponge tents pre- 
paratory to intra-uterine injections. In this connection he 
remarks : “ It must not be forgotten that the uterine injec- 17 
tion is to be always and invariably preceded by the use of 
the sponge tent; that this is an essential part of the treat- 
ment, and by no means to be neglected.” He asserts that 
after dilating the internal os by the sponge tent these in- 
jections are “simple and safe.” Many gynaecologists do not 
share this confidence in the harmlessness of intra-nterine 
injections. With medicated tents and other safer modes 
of treatment, just as effectual, if not more so, at hand, few 
wdll venture to run the risks of incurring the accidents fre- 
quently following intra-uterine injections. 
For the treatment of this disease the non-compressed pith 
of the corn-stalk, employed as a tent, is an admirable means 
of conveying medicines to the cavity of the womb. The 
cloth tents of Dr. Taliaferro are also good tents for this 
purpose. They are inferior to the corn-stalk tent in several 
particulars. They are liable to bend and are sometimes 
quite difficult of introduction when saturated with a fluid. 
A spasmodic contraction of the cervical canal always takes 
place when a stimulating application comes in contact with 
the mucous membrane. Under these circumstances the canal 
partially closes, and when the cloth tent is attempted to be 
introduced, it frequently bends before it can overcome the 
resistance. The corn-stalk tent is of easy introduction. 
Its rigidity overcomes any slight resistance. It absorbs 
fluids readily and does not bend, if of proper size, before 
entering the cervical canal. It is sometimes desirable to 
secure a limited degree of pressure upon the mucous mem- 
brane of the uterine canal. The cloth tent cannot be, to 
any considerable extent, a dilator. Its dilatation occurs 
before its introduction if medicated. It may slightly ex- 
pand in the uterine cavity if introduced dry, but being soft, 
cannot accomplish much in that way. For seven years I 
have been using the corn-stalk tent in the treatment of 18 
chronic endometritis. I do not employ tents to the exclu- 
sion of other methods of intra-uterine treatment; nor do I 
always medicate the tent. The corn-stalk tent alone, with- 
out medication, frequently affords the necessary amount of 
alterative action in the diseased membranes. Local treat- 
ment is not all the treatment necessary. There must be 
constitutional treatment as well. 
Case IY.—Chronic Endometritis, with Retroversion. Mrs. 
C., aged twenty-eight; married ; mother of three children, the 
youngest four years old. Since the birth of this child, she 
has been troubled with leucorrhoea, copious and almost pu- 
rulent at times. Pain in the back. Menstruates irregularly in 
time and quantity, and sometimes attended with pain. 
Tongue coated white. Pulse 90. Rests badly at night. 
Bowels constipated, lias lost flesh and appetite. Coughs, 
and thinks she is “consumptive.” lias bronchitis. Pound 
uterus, by touch, retroverted; os large, indented and vel- 
vety. Great relaxation of parts, with copious, thick, muco- 
purulent discharge filling the vaginal cul-de-sac. The spec- 
ulum revealed the cervix large, ragged and “ ulcerated 
the redness extending up as far as visible, with thick, cream- 
colored, muco-purulent secretion pouring from it when 
pressed. Probe caused some pain ; passed without much 
difficulty, following the retroverted cavity. The uterus was 
rotated into position by the probe, and a corn-stalk tent, 
slightly compressed, and saturated with tincture of iodine, 
carried into the uterus. The patient was requested to keep 
her bed and allow the tent to remain twelve or more hours, 
unless pain supervened, when it should be withdrawn. It 
was removed the next day. On my next visit, five days 
afterwards, I found the discharge had diminished. A tent 
was introduced as before. This treatment, varied to suit the 
conditions of the patient, was followed up at intervals of 19 
four to six or more days. Between intervals of treatment 
she was to use copious warm water injections, followed by in- 
jections of solution of chlorate of potassium and tannin. Cot- 
ton pessaries, as large as could be borne, moistened with gly- 
cerine, were to be inserted each morning and worn during the 
day. Prescriptions were made to correct the indigestion 
and constipation. She was ordered phosphated cod liver 
oil and bromide of potassium for promoting sleep at night. 
The treatment was continued for many months. Improve- 
ment was slow, but quite perceptible from the beginning. 
When the improvement had progressed sufficiently, treat- 
ment was had at longer intervals of time, and the cotton 
pessaries displaced by a well-fitted (Hodge-Smith) Fitch 
pessary. At this time, fifteen months after commencement 
of treatment, the patient is in excellent health and three 
months advanced in pregnancy. She still wears the pessary, 
which will be removed in a few weeks. 
Other uterine troubles are amenable to treatment by tents. 
In amenorrhcea, among other methods of treatment, Dr. 
Thomas recommends the introduction of a tent a few days 
before the expected period. lie also recommends its use 
in neuralgic dysmenorrhoea. 
The attention of the profession has been repeatedly called 
to the dangerous consequences often following the use of 
uterine tents. Metritis, peritonitis, septicsemic fever, 
tetanus, hysterical convulsions, etc., have all followed the 
use of the sponge tent. There are many serious objections 
to the sponge tent. The secretions are absorbed and retained, 
and are often decomposed in it while in contact with the 
mucous membrane. In expanding, the cells of the membrane 
are sunk in it, and on its withdrawal are torn and denuded, 
aiding the absorption of septic fiuids. 
The sea-tangle tent has been used as a substitute. Simi- 20 
lar accidents have, however, followed its employment. Of 
these tents, Dr. Sims writes: “ I have used the laminaria 
digitata, and think well of them, but they can never wholly 
replace the sponge tent.” It is possible that no tent can 
entirely replace the sponge tent, but the effort, in view of 
the dangers of that tent, must be constantly made. Dr. 
Thomas remarks: “ Had all the fatal cases which have re- 
sulted from accidents due to tents been faithfully recorded, 
the list would now be a long one, and it would be greatly 
lengthened by a record of all the instances in which tedious, 
exhausting and dangerous disease has thus been excited.” 
lie gives the following rules for the use of tents. These 
rules are well known to the profession, but I give them be- 
cause, in some respects, they do not apply to the corn-stalk 
tent, however much they may to the sponge tent: 
“ Rule 1. In the introduction of a tent, no force whatever 
should be employed. Should that first essayed not pass the 
os internum easily, it should be withdrawn and either bent 
so as to follow more accurately the course of the cervical 
canal, as ascertained by the probe, or exchanged for a smaller 
tent.” 
The observations in this rule give the experience of gyn- 
aecologists in the use of the sponge tent. The compressed 
sponge is exceedingly hard and wanting in pliability. Ho 
force should be used in its introduction. The corn-stalk 
tent is less irritating to the mucous membrane, and, made 
smooth, can be passed with a moderate degree of force. I 
have often employed a considerable amount of force, in cer- 
tain cases, in its introduction. The probe should always 
precede the introduction of the tent, in order to show the 
degree of curvature in the cervical canal, and to determine 
the size and length of the tent suited to the particular case. 
If curvature beyond that naturally existing occurs, it is easy, 21 
in a few minutes, to shape the curvature of the tent to that 
of the organ, by selecting a piece of the pith in which the 
eurve has been given it by nature in its growth. From this 
fact the fibres of the stalk are not cut across, but preserved 
in their natural direction. A tent made in this way may 
be introduced without difficulty. I have prepared these 
tents often after the introduction of the speculum and the 
probe, in a few minutes, after determining the size, curve, 
and length demanded by the particular case. 
Rule 2.—“ A tent should never, under any circumstances, 
be introduced at the physician’s office, and the patient 
allowed to go home with it in utero. Such practice is 
hazardous in the extreme. Even when introduced at the 
patient’s home, she should, at once, be confined to the 
recumbent posture, and kept perfectly quiet.” 
This rule applies to any tent used for the purpose of dila- 
tation ; and, while caution, in the use of tents, is always to 
be enjoined, it is nevertheless true, that the corn-stalk tent 
used without compression, can be worn without danger. 
After its introduction, I request the patient to keep the 
recumbent position for a few hours. But, often, they attend 
to their usual employments. They are directed, if the tent 
gives pain, to withdraw it, by the string attached. I will 
say here, that I rarely ever withdraw a medicated or non- 
compressed tent myself, but ask the patient to do so, after 
being properly instructed as to the manner of bringing it 
away. I tell her to pull gently, with a see-saw motion, and 
in the proper direction, and to use no undue amount of 
force. If it refuses to come away easily, I remove it. 
Rule 3.—“ The practitioner should always investigate as 
to the previous existence of chronic pelvic peritonitis, one of 
the most common of the diseases of women. Should it have 
•existed, tents should be carefully avoided. In some of the 22 
instances, in which I have seen dangerous results follow 
their use, this condition had previously existed, and been 
excited into action again by them.” 
Rule 4.—“ A tent should never be allowed to remain in 
the uterus more than twenty-four hours, and, if it be com- 
patible with the accomplishment of the desired result, it 
should be removed in twelve hours.” 
This rule applies again to the use of the sponge tent. I 
have often intentionally allowed the corn-stalk non-com- 
pressed tent to remain in the uterus for several days. I 
have never had any bad results from the practice, but it is 
well to state, I always instruct the patient to withdraw it at 
once upon the appearance of pain. It can be borne for a 
length of time, provided pain does not supervene. 
Rule 5.—“ After the removal of a tent, the vagina should 
be washed out with an antiseptic fluid, and if any pain, 
chilling or discomfort, follow the removal, opium should be 
freely administered and perfect rest enjoined.” 
The use of antiseptic fluids after the removal of the corn- 
stalk tent is unnecessary, as no decomposition occurs be- 
cause of its presence in the cervical canal. It has never 
been necessary to use opium for the purposes above sug- 
gested after the withdrawal of these tents. 
Rule 6.—“ After the removal of the tent the patient 
should be kept in bed at least twenty-four hours, and never 
allowed to travel before the expiration of four or five days.” 
The first part of this rule I have never observed in a 
single instance, when using the tent medicated. When em- 
ploying the corn stalk tent as a dilator, it is better to observe 
the rule, but it is not necessary to do so when using it non- 
compressed or as a medicated application. 
In speaking of sponge tents Dr. Sims declares he never 23 
uses them if he can possibly avoid doing so.* Indeed, so 
dangerous does he regard them, and so necessaay, if possi- 
ble, is it to find a substitute for them that he asserts that “ he 
who will give us an efficient, safe and cheap substitute for 
sponge tents will confer a great boon upon surgery.” 
I offer the corn-stalk tent as a “ safe and cheap substi- 
tute.” It remains to be seen if it shall, in the hands of the 
the profession, prove “ efficient.” As before stated, I have 
used this tent for the last seven years, testing it before 
giving it to the profession. During this time I have not 
had a single accident from its use and have introduced it 
many hundreds of times. 
Its advantages I will enumerate as follows; 
It dilates effectually, but not too rapidly. 
It is smooth, soft, and can be removed without force. 
It produces no lacerations, abrasions, or irritation of the 
mucous membrane. 
It can be medicated with any substance, as easily as the 
sponge or cloth tent. 
It is of vegetable origin, and, hence, does not become putrid 
and poisonous to the patient 
It may be retained, non-compressed, for days, without in- 
jurious results, if no pain occurs. 
A number of small tents, filling up the cervical canal, may 
be used for more rapid expansion. 
It can be prepared in a few minutes, of any desired curve, 
size and length. 
Any degree of compression may be given it, or it may be 
used without compression. 
* The dangerous character of the sponge, when used as a tent, is easily explained 
When taken from the sea it is “ a black, gelatinous mass, emitting a very disagreeable 
odor, which increases as the mass putrefies. These black masses forming the sponges 
are taken ashore where they are either buried in the sand or exposed to the sun for 
several days ; after decomposition has ceased, the sponges are beaten with clubs, this 
beating removing many of the dead animals in the form of black dust. ” 24 
It may be perforated, like the sea-tangle, and its power of 
absorption increased, by pricking its surface. 
The introduction of the corn-stalk tent is, usually, no diffi- 
cult matter. I introduce it before or after inserting the 
speculum, but prefer the latter method, as a rule. After 
bringing the os into view, by means of the speculum (which 
can easily be done, except in cases of anteversion, when the 
tenaculum will aid in bringing it in view,) the tent is carried 
to the os uteri, affixed to a stick eight or ten inches in 
length, by means of a needle fixed in the end of the stick. 
Holding the small end of the tent in the os, the uterine 
probe, or a small rod, is placed firmly upon the tent, near 
the point of insertion of the needle. The stick, in which 
the needle is fixed, is withdrawn, and the tent pushed, 
gently but firmly, up the cervical canal by the probe. 
Between the end of the tent and the probe, the latter being 
held firmly against the tent, a kind of universal joint is 
formed, permitting the tent to take the surest and easiest di- 
rection into the uterus. Frequently, the uterus ascends before 
the tent (especially if a little too large), as it is being pressed 
into the cervical canal; and, in straightening the canal, 
where there exist curvatures from flexions or versions, the 
probe end of the tent falls back upon the posterior wall of 
the vagina. The speculum is withdrawn an inch or so, 
while the probe, with the tent almost at a right angle with 
it, lifts the tent into the cervical canal, out of sight, where 
it is left, a string having been attached to it, by which it 
may be withdrawn. I endeavor, always, to carry the large 
end (probe end) of the tent a short distance within the os 
uteri. When this is done, it is less liable to escape from the 
canal into the vagina. The size of the tent should always 
admit of easy introduction. Slight force will, however, do 
no harm. It is well to place a packing of cotton, with glyce- 25 
vine, around and upon the os uteri, before removing the 
speculum. 
As stated, I allow the patient to withdraw the tent, when 
not used as a dilator. The physician, in removing the tent, 
should do so with the lingers, and never through the spec- 
ulum, as air may be admitted to the uterine cavity, and bad 
results follow.