. Essentials of gynecology, arranged in the form of questions and answers prepared especially for students of medicine ... Introduction of Pessary, First Stage (Hart and Barbour). ulceration. The pessary should be removed and cleaned about oncea month, though they frequently remain in place several monthswithout causing trouble; in the meantime the patient should be in-structed to use a vaginal douche for cleanliness two to three times aweek. Always before re-inserting the pessary examine the posteriorfornix through a speculum to see that no pressure sore is forming. 140 ESSENTIALS OF riYN^COL
. Essentials of gynecology, arranged in the form of questions and answers prepared especially for students of medicine ... Introduction of Pessary, First Stage (Hart and Barbour). ulceration. The pessary should be removed and cleaned about oncea month, though they frequently remain in place several monthswithout causing trouble; in the meantime the patient should be in-structed to use a vaginal douche for cleanliness two to three times aweek. Always before re-inserting the pessary examine the posteriorfornix through a speculum to see that no pressure sore is forming. 140 ESSENTIALS OF riYN^COLOGY. What are the operative procedures for holding a retro\erteduterus in place after reposition ?a. Alexanders operation: h. Hysterorrhaplij^; c. Intra-abdom-inal operations on the round hgaments. Describe briefly Alexanders operation. Alexanders operation for shortening the round ligaments is per-formed as follows : The skin about the pubes is shaved and prepared Fig. Seconl Stage : Pe-sary carried on by Finger (Hart and P> .rboiir). antiseptically; the pubic spine is taken as the first landmark; anincision is then made, 2 inches long, from that point upward andoutward, in the direction of the inguinal canal; the incision is deep-ened until the tendon of the external oblique is seen : the externalabdominal ring is now visible; the intercolumnar fascia is cutthrough in the long diameter of the ring; if necessary the incisionmay be continued up to the internal ring; the ronnd ligament can PESSARIES. 141 usually now be seen, with tlie genital branch of the genito-cruralnerve along its anterior surface. The ligament is then sei^aratedfrom neighboring structures and gently drawn out a little to showthat it is free. Alexander then leaves this side covered with a cleansponge and operates on the other side in the same way. The uterusis then thrown forward by tlie sound in the hands of an assistantand the ligaments drawn out till they are felt to control
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