Gynecology . the vagina should also be packed. In about twenty-four hours the packing is removed. During the interval before the main opera-tion formalin douches (1 to 2 per cent.) are given daily. The patient is keptout of doors as much as possible and supporting treatment given for about aweek or ten days. The Operation.—A thorough bowel preparation is very necessary, so thatthe intestines may be well collapsed at the time of operation. The catharsis HYSTERECTOMY OPERATIONS 635 should be given the second night before the operation, so that the patient mayhave an undisturbed night preceding t
Gynecology . the vagina should also be packed. In about twenty-four hours the packing is removed. During the interval before the main opera-tion formalin douches (1 to 2 per cent.) are given daily. The patient is keptout of doors as much as possible and supporting treatment given for about aweek or ten days. The Operation.—A thorough bowel preparation is very necessary, so thatthe intestines may be well collapsed at the time of operation. The catharsis HYSTERECTOMY OPERATIONS 635 should be given the second night before the operation, so that the patient mayhave an undisturbed night preceding the operation. The usual abdominal andvaginal preparation is carried out. When the patient has been anesthetizedthe vagina is wiped dry and then thoroughly painted with iodin. It is notnecessary to leave a gauze packing in the vagina if the iodin application isproperly done. In performing the operation it is important to carry out a very systematicline of procedure in order to save as much time as Fig. 342.—Vaginal Hysterectomy. Final the anterior and posterior walls of the vagina. (1) Opening the Abdominal Cavity.—It is advantageous to have the patientin a steep Trendelenburg position, which in our experience does not possessthe dangers very commonly attributed to it. It is important that the weight ofthe patient should be partly supported by well-padded shoulder-braces. Theabdomen may be opened by a very long median incision reaching from thepubes to the umbilicus. This is the incision usually employed in this country,and, as a rule, gives plenty of room. The transverse incision carried directlyacross the abdominal muscles, as depicted in Fig. 343, exposes the field of opera-tion more completely than does the longitudinal opening. We have not found 636 GYNECOLOGY *
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