2 succussion unbearable. Instead, in his monumental treatise, “Gynecology,” Soranus prescribed the following: “. . . bathe the prolapsed part of the uterus with much lukewarm olive oil, and make a woolen tampon corresponding in shape and diameter to the vagina and wrap it in very thin clean linen. . . one should dip it brieﬂy in vinegar. . . acacia juice. . . or wine, and apply it to the uterus and move the whole prolapsed part, forcing it up gently until the uterus has reverted to its proper place and the whole mass of wool is in the vagina” [4]. Yet, despite this therapeutic advance, outdated notions about the uterus would persist. As late as the second century C.E., prominent Greek physician Aretaeus the Cappadocian, in his “Causes and Indications of Acute and Chronic Diseases,” still described the uterus as, “an animal within an animal” [5]. Despite Soranus’s vast knowledge of obstetrics and gyne- cology, female pelvic anatomy remained poorly understood. Physicians of the age commonly referred to the uterus as mater (Latin for mother) or hystera (Greek for womb) in the plural form, believing the uterus consisted of more than one chamber [3]. Had it not been for Rome’s prohibition on the use of human cadavers, this belief might have been dispelled by the work of Galen, the Rome based physician and anatomist. However, Galen was left to extrapolate his understanding of human anatomy from dissections and vivisections of lower animals in which the ﬁnding of uterine horns was commonplace [3]. The Mediaeval era brought about a return to theurgy, and medicine, including the management of uterine prolapse, regressed. It was during the Middle Ages that fantastical con- cepts regarding female pelvic anatomy emerged. The seven cells doctrine was one such concept. It stated that the uterus consisted of seven compartments, three on each side and one in the middle and posited that female fetuses developed on the left, male fetuses on the right, hermaphrodites in the middle [6]. Beliefs from the Hippocratic era resurfaced and as late as 1603, a text by Roderigo de Castro advised that the prolapsed uterus, “be attacked with a red-hot iron as if to burn, whereupon fright will force the prolapsed part to recede into the vagina” [3]. While the practice of medicine during the Middle Ages left much to be desired, in the middle of the ﬁfteenth century changes in the way people thought about art and philosophy would soon lead to new ways of thinking in medicine. The Renaissance grew out of Florence where a collection of artists and intellectuals began to focus on the works and ways of the classical age. This led to a renewed attention to the beauty of nature, including the human form [7]. Artists took part in private anatomic dissections to advance their training, something physicians of that time had yet to do in a consistent way [3]. Unfortunately, drawings by master artists such as Leonardo di Vinci did not receive notice by the physicians of the era, but the works of others would. In the early sixteenth century, Berengario da Carpi, professor at Bologna and Pavia, would produce drawings of the female uterus and would be the ﬁrst to state clearly that the uterus consisted of one cavity [3, 6]. Two decades later Andreus Vesalius, professor of anatomy at Padua, with the aid of his illustrator, John of Calcar, would produce his epochal, “De Corporis Humani Fabrica.” In this work, Vesalius would Obstetrics and Gynecology International reproduce an accurate description of the entire female genital tract including the ligaments of the uterus [6]. With this accomplishment, Vesalius and his disciples lifted the veil that had obscured the intricacies of the female genitourinary tract, ultimately helping physicians to better understand female pelvic ﬂoor anatomy. 3. Evolution of the Pessary By the close of the sixteenth century, the management of uterine prolapse became more ﬁrmly rooted in the use of pes- saries. Pessaries would evolve from lint balls or halved fruit soaked in vinegar to something closer to their modern form. This shift was largely due to the inventiveness of France’s royal surgeon, Ambroise Pare´. Pare´ devised oval shaped pessaries of brass and waxed cork. He attached thread to them to facilitate their removal, while others were to be worn with belts to help them remain in situ [8]. In the eighteenth century, Henrick van Deventer, who started his career as a goldsmith, made pessaries of various shapes and sizes out of waxed cork or wood, and metals such as silver and gold [9]. By the mid-nineteenth century, pessary use had become quite common. Yet, alternative methods of managing prolapse were still prescribed. These included the use of astringents such as tannin and alum; cold sitz baths, surf bathing, and sea-water douches; postural exercises; Brandt’s “uterine gymnastics” which embodied anointing, massage, and manual replacement of the prolapsed parts; leeching; torsion of the uterus; attempts to produce ﬁbrosis of the surrounding tissues by the introduction of gonorrheal exudates into the vagina or the deliberate induction of pelvic peritonitis [10]. Hugh Hodge of Philadelphia (who was concerned with ailments he believed to be caused by uterine retroversion) was a major proponent of pessary use. He shared the sentiments of many gynecologists in the United States and abroad when, in 1860, he proclaimed pessary use to be the “sine qua non” for the treatment of uterine displacements [11]. He put forth the following as the ideal qualities for a pessary: it should be made of incorruptible material, maintain the normal uterine position, allow for natural movement, be worn without pain, and not excite leucorrhea or menorrhagia [12]. The ﬁrst of these, to be incorruptible, came to pass in 1844 when Charles Goodyear was granted U.S. patent no. 3,633 for the invention of vulcanized rubber [13]. Before then, pessaries had consisted of wax, wood, leather, glass, and metal. Now a material could be used that resisted decomposition. This ultimately led to the develop- ment of Hodge’s eponymous lever pessary and was followed by an explosion in the number and variety of pessaries put to use by gynecologists. It was said in those years that fortunes were made by two groups of gynecologists: those who inserted pessaries and those who removed them (a bit reminiscent of vaginal mesh use today) [12]. However, not everyone in the profession was so keen on pessary use. In 1866, during his satirical presidential address to the New Hampshire State Medical Society, W. D. Buck commented, “The Transactions of the National Medical Association for 1864 has ﬁgured one hundred and