Transactions of the American Association of Obstetricians and Gynecologists for the year ... . skill and the accessories are available. But it isout in the field where emergencies arise in which promptaction is essential and such conditions cannot be obtained. The methods of dilatation that have served me best are two—manual and instrumental. Manual dilatation, in which thefingers are used as dilators, I really deem of most importance, 89 90 HENRY S. LOTT, because it is always available and with a clean hand is compara-tively safe. The index-finger (its tip being most conical), iswwmed into th
Transactions of the American Association of Obstetricians and Gynecologists for the year ... . skill and the accessories are available. But it isout in the field where emergencies arise in which promptaction is essential and such conditions cannot be obtained. The methods of dilatation that have served me best are two—manual and instrumental. Manual dilatation, in which thefingers are used as dilators, I really deem of most importance, 89 90 HENRY S. LOTT, because it is always available and with a clean hand is compara-tively safe. The index-finger (its tip being most conical), iswwmed into the os by a spiral motion, and with it gentletraction is made toward the symphysis, sufficient force beingused to gradually make room for the introduction of the middlefinger. Now, the index-finger is held taut, its fixed point inclin-ing to the anterior portion of the cervix, while the middle finger,introduced to the full distance of its first joint, is repeatedlyflexed with force, thus making room for the ring finger, wdthwhich force is applied to the encircling os in like manner as with. the middle one. Through this maneuver room is made for thelittle finger and also, often simultaneously, for the thumb. Uponthe introduction of the latter, the leverage becomes most power-ful and the dilatation is soon accomplished. An excellent method of practising this maneuver is by makinga closed circle with the thumb and index-finger of the left handand then dilating it with the fingers of the right. The result of this method of dilatation, especially under chlo-roform, is very prompt, and the dilatation is effected without theintroduction of foreign bodies into the uterine cavity. It maybe practised at any time with the two hands, used at almost anystage of gestation, after the very early months, and, when thefingers are properly educated and the muscles trained to theirwork, dilatation can be accomplished in a very few minutes. The second method—instrumental dilatation—is one devis
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