. The Medical and surgical reporter . the free margins of the rectal andof the vaginal flaps are separated, with thetissues drawn by the sutures from each side,and thus present a barrier to further descent,while at the same time we have lessened theprojecting mass.; furthermore, by making ahorse-shoe separation at the sides of the June 8, 1889. Communications. 675 vulvar entrance we can throw the vaginalflap further forward, and thus greatly lessenthat entrance. Mr. Tait informed me thathe was trying a somewhat similar operationfor cystocele, but had not yet brought it tosuch perfection of met
. The Medical and surgical reporter . the free margins of the rectal andof the vaginal flaps are separated, with thetissues drawn by the sutures from each side,and thus present a barrier to further descent,while at the same time we have lessened theprojecting mass.; furthermore, by making ahorse-shoe separation at the sides of the June 8, 1889. Communications. 675 vulvar entrance we can throw the vaginalflap further forward, and thus greatly lessenthat entrance. Mr. Tait informed me thathe was trying a somewhat similar operationfor cystocele, but had not yet brought it tosuch perfection of method that he was will-ing to describe it. Mr. Tait, in his operation, employs forstitches, as has been mentioned, silkwormgut, and the statement made in Vullietsand Lutauds recent 1 volume, that silverwire is used, is an error. The next illustration, Figure 3, shows theoperation as begun; the patient is lyingupon her back, two assistants, one on eachside, while supporting the lower limbs well-flexed upon the body, press with the thumb. Fig. 3.* or index finger so as to make the perineumtense; the operator has two fingers of theleft hand in the rectum, and enters the scis-sors about midway in the transverse line tobe incised. This beginning at the middle,instead of upon one side as advised by , is of course not an essential, but it hasseemed to me somewhat easier. Next, one-half of the transverse line, as shown inFigure 1 is made, then the other half; thetwo oblique lines toward the anus are nextcut, then those at the vulvar margin, theextent of the latter being longer, as greaterlessening of the outlet is required. Finally,the two flaps are by quick clips of the scis- 1 Lemons de Gynecologie Operatoire, Paris, 1889. * The figure represents the flat of the scissors asparallel to the skin, whereas it should be perpendic-ular to it, so that a transverse incision will be made. sors separated to a uniform distance on eachside, and to such height as may be neces-sary. Figure 4
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