. Clinical gyncology, medical and surgical. y for suchwork by Fritschj the iodo-form gauze tampon orsponge, which I usuallyplace within the peritonealcavity after opening thecul-de-sac of Douglas, toprevent the intestines andomentum from prolapsingand hindering the work, isremoved, and the pelviccavity is irrigated with astream of warm stumps of the broadligaments are now drawndown with bullet-forcepssufficiently to give a clearview and to bring them completely into the vagina, and a full-curved needleis introduced through them on either side, entering anteriorly through thevagino-pe
. Clinical gyncology, medical and surgical. y for suchwork by Fritschj the iodo-form gauze tampon orsponge, which I usuallyplace within the peritonealcavity after opening thecul-de-sac of Douglas, toprevent the intestines andomentum from prolapsingand hindering the work, isremoved, and the pelviccavity is irrigated with astream of warm stumps of the broadligaments are now drawndown with bullet-forcepssufficiently to give a clearview and to bring them completely into the vagina, and a full-curved needleis introduced through them on either side, entering anteriorly through thevagino-peritoneal margin and emerging posteriorly in the same manner, andthe ligature is tied. The opening in the vagina still remaining is closedwith two or three sutures. All remaining ends of sutures arc cut off, thevagina is irrigated with Thierschs solution, and a small strip of iodoformgauze is introduced. This is the best method, and patients SO treated have been dismissedwithin ten days. It must, however, be frequently modified according to. Vaginal hysterectomy. The bladder has been separatedfrom the cervix and the peritoneum, and the vaginal mucousmembrane united with a continuous catgut suture. The ex-ternal cervical opening is closed with a continuous silk sutureat the beginning of the operation. 616 MALIGNANT NEOPLASMS OF THE UTERUS. Fig. 20. the case, one of the most frequent variations being, if ligatures are usodfor the operation, to put a small strip of gauze in the vaginal slit still left,and to drain for twenty-four or forty-eight hours. This is done when peri-toneal adhesions have been separated which give rise to oozing. FormerlyI did not suture the peritoneum to the vaginal mucous membrane, neitherAvas I particular about attaching my stumps in the vagina, yet my patientsmade good recoveries; but the convalescence was longer, and the procedureis obviously not so surgical, and necessarily, from a theoretical stand-point,is more dangerous. The gauze drainage in such c
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