. The diagnosis and treatment of diseases of women. e is sufficient tension on the round ligament to bringthe uterus well forward, the peritoneum over the ligament loop may be incised and theligament itself grasped and drawn out as desired. (Crossen—Journal of American Medi-cal Association.) coil might slip. If doubtful on this point, the forceps may be carried to within halfan inch of the ring or even practically to the ring before puncturing. The peri-toneum, being freely movable on account of the loose subperitoneal tissue, is drawninward and puckered when the proximal portion of the ligame
. The diagnosis and treatment of diseases of women. e is sufficient tension on the round ligament to bringthe uterus well forward, the peritoneum over the ligament loop may be incised and theligament itself grasped and drawn out as desired. (Crossen—Journal of American Medi-cal Association.) coil might slip. If doubtful on this point, the forceps may be carried to within halfan inch of the ring or even practically to the ring before puncturing. The peri-toneum, being freely movable on account of the loose subperitoneal tissue, is drawninward and puckered when the proximal portion of the ligament is drawn tense to 61S DISPLACEMENTS OF THE UTERUS bring the uterus forward. This brings the peritoneal exit near the aponeuroticexit of the new hgament, beneatli the rectus muscle. The direction of the newhgament therefore is forward, practically the same as in the Gilliam operation. 4. The ligaments then fastened in their new position. If long enough, theloops are overlapped in the median line and fastened to each other and to the upper. Fig. 604. The Use of the Puncturing Tenaculum-forceps in the regular Gilliam-Fergu-son Operation. The puncture is made directly through the upper sheath, the rectusmuscle, the lower sheath and the peritoneum, and the liganient is grasped and brought out— the puckering suture having been previously passed. After the ligament is broughtout as desired, the puckering suture is tied, thus closing the opening at the side betweenthe distal portion of the round ligament and the anterior abdominal wall. (Crossen—Journal of American Medical Association.) sheath of the rectus. If not long enough to reach to the median line, they arefastened securely in the forceps-track by catgut sutures passed through the uppersheath and the ligaments beneath. The abdominal incision is then closed in theusual way. By the method just detailed, the ligaments may be transplanted into the ab-dominal wall very quickly—^giving a strong reliable forward and upw
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