. Clinical gyncology, medical and surgical. s. As to the latter, however, should it be found that the diseasehas involved the retro-uterine tissues, and that its excision or destructionby the cautery cannot be effected without opening the peritoneal cavity, MALIGNANT NEOPLASMS OF THE UTERUS. 609 there need be no hesitation in doing this, as no harm is apt to result fromit, whether done accidentally or by design. Should it be evident at theoutset that the operation, in order to be thorough, must include a portionof the cul-de-sac, it will be better to make the line of incision anterior tothis u
. Clinical gyncology, medical and surgical. s. As to the latter, however, should it be found that the diseasehas involved the retro-uterine tissues, and that its excision or destructionby the cautery cannot be effected without opening the peritoneal cavity, MALIGNANT NEOPLASMS OF THE UTERUS. 609 there need be no hesitation in doing this, as no harm is apt to result fromit, whether done accidentally or by design. Should it be evident at theoutset that the operation, in order to be thorough, must include a portionof the cul-de-sac, it will be better to make the line of incision anterior tothis until the cervix has been removal, leaving the excision of the retro-uterine parts by the cautery knife as the final proceeding. Under thesecircumstances all that will be needed will be an antiseptic tampon properlyapplied. In making the circular incision, the cold cautery knife (Fig. 12),slightly curved, should be applied close up to the vaginal junction, and,from the moment that the current is turned on, should be kept in contact Fto. The carcinomatous cervix exposed by speculum, the uterus steadied with double diverging tenacu-lum, and the cautery knife applied. The lines show the course which the knife should take, accordingto the Invasion of the neoplasm. with the parts to be incised. Before removing the electrode for any pur-pose, such as change of position or altering the curve of the knife, thecurrent should be stopped, and before continuing incision the instrumentshould be placed in position while cool. In other words, if the knife beheated before operation, even though to only a dull red, and applied to partsat all vascular, more or less hemorrhage will certainly follow; whereasif the cool platinum blade is already in contact with moisture as the currentis being transformed into heat, vessels are shrunken or closed even beforethey are severed. This is a very important point, and should never be lostsight of in cautery operations. The circular incision having been
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