Treatise on gynæcology : medical and surgical . indispensable, areto be preferred. METHODS OF GYNAECOLOGICAL EXAMINATION. 117 An incision of 1 cm. to cm. on either side is enough for thepassage of the index, which will accomplish the required dilatationitself. After the exploration is complete, the uterus should be irri-gated and the cuts closed with catgut. B. Complete Bilateral Division of the Cervix.—This procedure isso truly an operation that one should not undertake it if he has notalready a large experience in uterine surgery. A necessary prelim-inary is ligation of the uterine arter
Treatise on gynæcology : medical and surgical . indispensable, areto be preferred. METHODS OF GYNAECOLOGICAL EXAMINATION. 117 An incision of 1 cm. to cm. on either side is enough for thepassage of the index, which will accomplish the required dilatationitself. After the exploration is complete, the uterus should be irri-gated and the cuts closed with catgut. B. Complete Bilateral Division of the Cervix.—This procedure isso truly an operation that one should not undertake it if he has notalready a large experience in uterine surgery. A necessary prelim-inary is ligation of the uterine The patient being anaes-thetized and placed in the dorso-sacral position, the vagina is stronglyretracted upon one side, while the cervix is drawn with a tenaculumtoward the opposite side; in this manner one of the lateral vaginalpouches will be exposed. Then a long and strongly-curved needle, orbetter a Deschamps needle, threaded with silk, is passed through thecul-de-sac across the finger outside of the cervix, taking care anteriorly. Fig. 85.—Kuechenheisters Scissors. not to go beyond a line tangent to the circumference of the cervix atthat level in order to avoid the ureter. The surgeon must include thegreatest possible thickness of tissue and must bring his needle out inthe vagina posteriorly, as nearly as possible to the point of entranceand always at the same distance from the os. In thus keeping thepoints of the needles entrance and exit close together, -the surgeonendeavors to include as little as possible of the vaginal mucous mem-hrane within the loop of his ligature. The silk is then firmly tiedand the process repeated on the opposite side. I have had occasion to make use of this preliminary ligationand can state that it is very efficacious. I think that it is not themain trunk of the artery which is included in the ligature, butprobably its inferior branches; however that may be, the surgicalxesult is excellent. One can then take up his bistoury with no f
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