The Hahnemannian monthly . gt;erationis considered by many almost, if not quite, perfect. My objectionto it is, primarily, that it does not bring the divided structures to-gether at the median line, which is their normal point of attach-ment, so that the median line of the vaginal axis is left the weakestpoint of the repaired floor. Again, the Emmet operation is a tediousone to perform, involves unnecessary loss of tissue, and does not re- 346 T?te Hahnemannian Monthly. [June, store the perineal body, should this structure be implicated in theinjury. Fritsch, Hegar, Bischoff, and Simon (Fig. 7
The Hahnemannian monthly . gt;erationis considered by many almost, if not quite, perfect. My objectionto it is, primarily, that it does not bring the divided structures to-gether at the median line, which is their normal point of attach-ment, so that the median line of the vaginal axis is left the weakestpoint of the repaired floor. Again, the Emmet operation is a tediousone to perform, involves unnecessary loss of tissue, and does not re- 346 T?te Hahnemannian Monthly. [June, store the perineal body, should this structure be implicated in theinjury. Fritsch, Hegar, Bischoff, and Simon (Fig. 7), as well as manyothers, have devised areas of denudation within the vagina for thepurpose of overcoming the rectocele and relaxation, all of whichare unsatisfactory because no posterior median denudation can reachthe separated structures, which are retracted high up in the flap-splitting operation, as ordinarily performed, restores theperineal body, but does not overcome the rectocele. I have, accord- Fig. a, b, line of incision. ingly, combined Taits and Doleriss flap-splitting method withSchroeders method of detaching the mucous membrane, and my ownmethod of suturing, with results which to me are eminently satis-factory. In describing my technique I shall largely follow the de-scription given in my recent work on gynaecology.* I have nowperformed the operation more than one hundred times, and have yetto meet with my first failure. I proceed as follows: The patient is placed in the usual lithotomy posture, with an as-sistant on either side who retract the labia with the fingers. The * J. Text-Bonk of Gynecology, Boericke & Tafel, 1894. L894.] R{ luxation of the Pelvic Floor. 347 index finger of the left hand is carried into the rectum to serve as aguide. The character of the transverse incision will depend uponthe extent of the perineal rent. If the perineal body is not torn,and the condition is one of simple relaxation, it is made with a pairof angular sciss
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