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initial stimulus of strong psychic impulses, had an astonish-
ing effect in this case. And this result is specially of interest
—and has been so fully recounted here—because it points a
moral in pelvic exercises. Even though the initial psychic
impulse will generally be less pronounced than the emotional
enthusiasm of a convert, we must accept the fact that, in the
early stages of prolapse, voluntary contractions of the peri-
vaginal muscles may exert a very favourable influence. Many
other trained observers confirm this view.
And I entirely concur with the view of Max Hirsch (34) that
the preservative and remedial treatment of atonic pelvic
muscles through exercises is a very fruitful therapeutic field.
He writes : " Unfortunately, these possibilities of treatment
are much neglected and hardly employed because the early
stages of vaginal and rectal prolapse escape observation, and
the later stages, which are patent and visible, are generally
treated by means of appliances (pessaries) or operations.
And yet the timely treatment of early stages is likely to save
patients from the—frequently serious—consequences of
operations which are not by any means always successful.''
And he draws the inference that all asthenic or muscularly
atonic women—i.e., those whose muscular tissues are
congenitally slack and weak—should perform pelvic exercises
as a preventive and prophylactic measure to avoid prolapse :
an opinion which I entirely endorse.
And so we may pass to the consideration of the remedial
treatment of the pelvic floor after childbirth, and to the whole
subject of physical culture during pregnancy and in the
puerperium.
