Operative gynecology : . partly effected, the loosened vagina is cut through with scissors and the car-cinoma detached, and finally, after releasing the bladder, the cervix uteri istied off. If the uterus is not to be removed, the separation of vagina andrectum is carried up to the cervix uteri, and the vagina in the neighborhoodof the disease is freed on all sides from the subjacent tissue. An incision isthen made info the vagina at a suitable point and the diseased portion excised 334 DISEASES OF THE VAGINA. with scissors. In a contracted vagina the last part of the excision is facili-tated
Operative gynecology : . partly effected, the loosened vagina is cut through with scissors and the car-cinoma detached, and finally, after releasing the bladder, the cervix uteri istied off. If the uterus is not to be removed, the separation of vagina andrectum is carried up to the cervix uteri, and the vagina in the neighborhoodof the disease is freed on all sides from the subjacent tissue. An incision isthen made info the vagina at a suitable point and the diseased portion excised 334 DISEASES OF THE VAGINA. with scissors. In a contracted vagina the last part of the excision is facili-tated by splitting its posterior wall from the frenulum up, giving a broad viewof the field. I prefer the fourth plan, extirpation by an incision beside the rectum, tothis, as less awkward and as enabling the operator to reach the parts moredirectly, as in the following case. The cancerous patch was situated at the vault of the vagina posteriorly; itwas 3 by 4 cm. ( by inches) in diameter, and involved the outer surface. Fig. 204. -A Case of Adenocarcinoma of the Posterior Vaginal Wall by Implantation from an UNSUSPECTED AdENO-CARCINOMA OF THE BODY OF THE UTERUS. of the cervix as well. The diseased area could not be drawn down, so as toattack it from below, so the patient was placed upon her left side, an incisionmade from the end of the sacrum, beside the coccyx, and continued in a slightlycurved line down beside the rectum and around the right margin of the anus, TRAUMATIC AFFECTIONS. 335 through the perineum to the fourchette. By carrying the incision deep enoughthe rectum was exj>osed and easily drawn toward the left with retractors, inthis way exposing the vagina. The posterior vaginal wall was then split, fromthe fourchette to the cervix, the diseased portion freed at the sides with the fin-gers, and removed. It included the posteriortwo-thirds of the upper portion of the vaginaand the posterior lip of the cervix above thevault. The uterus was now brought down inretro
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