Gold Stemmed Pessaries: A Shadow of the Past

Pessary

Although the above medical device appears to just be a thingamajig from the local hardware store, it is not. It is a gold, spring-stem wishbone pessary first developed in Germany in the 1880s and used through the late 1930s. Generally, today’s medical pessaries are used for three types of issues: a supportive device for organ prolapse, a vaginal suppository for delivering pharmacologic preparations, and birth control. The type of spring-stem wishbone pessary found in the Nixon Library is described as a remedy for uterine malposition or bleeding complaints, yet it is also widely recognized as an early modern intrauterine device.

Stones and Goop

The word pessary derives from the Greek word pessόs, which means oval stone similar to ones used in ancient checkers.  Historically, stone pessaries were used to remedy organ prolapse and women in New Zealand were noted to place pebbles in the uterus to foster sterility. Stories abound of small rocks inserted into the uteri of camels during long desert journeys to disrupt the uterine cavity and prevent pregnancy. This could not have been at all comfortable for woman or beast.

For thousands of years, cultures around the globe used cervical pessaries and documented an understanding of barrier contraceptive methods.  Inventive birth control mixtures, often combined with magic and ritual, might include viscous pastes of honey, rancid oil, animal dung, tree resin, dates, or fermented acadia leaves soaked with lint.

By the time the late 19th century rolled around, pessaries evolved to include metal cervico-uterine models.  Physician Carl Hollweg patented a wishbone pessary in 1902 designed to “support the uterus”, and specifically, “prevent excessive and abnormal bending of this organ and to obviate and break apart any abnormal growth of tissue. . . ” Considering Hollweg’s description, it seems birth control was an unintended gain from this pessary. During the cervico-uterine heyday, the most well known wishbone spring-stem pessary in the United States was the Ideal, also known as the brooch, the butterfly, or the wishbone stem.

Arrangements and Regrets

Proper placement of the wishbone spring-stem pessary required a visit to a physician. The two flexible arms were squeezed together to create a linear form and encased in a gelatinous material to facilitate entry into the uterus. After insertion, the pessary’s concave button rested against the the external os and the spring stem sat within the cervical canal. When the gel casing melted due to body temperature, the arms would spring out laterally and the oval tips maintained the device’s position within the uterine cavity. Due to infection concerns, a physician typically left the wishbone pessary in place for only two to three months before removal. Once the uterus was free from a foreign object for several months, the pessary was reinserted.

Perforated uterus due to spring-stem pessary It eventually became clear that using a stem pessary, which left the uterus vulnerable to pathogens, could be dangerous. Wishbone stem pessaries fell out of favor as evidence of infection, uterine perforation, and death began to mount. Additionally, some women who used this type of pessary for birth control experienced a level of unreliability resulting in unintended pregnancy. These multiple side effects prompted improved intrauterine designs similar to what we see today.

Out of the Shadows

The Nixon Library owns two examples of gold-filled wishbone spring-stem pessaries. One is stamped “14K”, is approximately 0.5 inches in in diameter, and 2.5 inches in length.  The other is marked “GOLD”, approximately 1.0 inch in diameter, and 2.5 inches in length.  A concave disc supports a coiled stem at which two thin metal arms with flat, oval tipped ends project into a “V” position.

It would be our pleasure to bring these pessaries out of the historical shadows for viewing.  If you would like to examine these golden pessaries in person, please contact Mellisa DeThorne at DETHORNE@uthscsa.edu

Sources:

Cooper, J. F. (1928). Technique of contraception. New York, NY: Day-Nichols

Himes, N. E. (1934). Medical history of contraception. The New England Journal of Medicine, 210(11), 576-581.

Hollweg, C. (1902). U.S. Patent No. 709675. Washington, DC: U.S. Patent and Trademark Office. Retrieved August 2017 from: https://www.google.com/patents/us709675.

Oliver, R., Thakar, R., & Sultan, A. H. (2011). The history and usage of the vaginal pessary: A review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 156(2), 125-130.

Image sources:

Fotinos, D. (2017). Gold Spring-Stem Pessaries [Digital photograph].

Penetration of the uterus by gold stem pessary. [Online photograph]. Retrieved August 2017 from: www.jamanetwork.com/journals/jama/fullarticle/242995. doi:10.1001/jama.1933.27420190001008

[Untitled photograph of spring stem pessary with box]. Retrieved August 2017 from: www.fcgapultoscollection.com

-Diane Fotinos, B.S., PA