266 Diseases of the Genital Organs 



will generally be found "ballooned" or will quickly become 

 inflated under manual movements. If the solution is thrown 

 out, the vagina may collapse and closely invest the hand. In 

 this case more of the liquid should be injected, and it will 

 again dilate. If the hand is introduced without the knife, 

 withdrawn, and then introduced with it, it will frequently 

 be found that the vagina has collapsed and needs a second 

 filling with the fluid. Patience until dilation is accomplished 

 and promptness to act when it is attained are prime requi- 

 sites to success. 



The knife should be pushed through the vagina quickly, 

 making a clean wound the width of the blade, and the latter 

 withdrawn and laid aside. It should be remembered that in 

 this "ballooned" state, the anterior wall of the vagina is but 

 2 or 3 mm. thick and easily penetrated. Introduce the hand 

 again, push one finger into the incision, then a second and 

 third, and eventually, holding all the fingers in the form of a 

 cone, push the entire hand into the peritoneal cavity. Im- 

 mediately below the incision and continuous with the tissues 

 involved in the wound, lies the uterus, with a transverse di- 

 ameter of 4 to 6 cm. With the palm of the hand downward, 

 trace the uterus forward 15 to 18 cm., where it ends abruptly 

 in two cornua of about the same size as the body, which are 

 given off horizontally at almost right angles. Trace these to 

 the right and left for 14 or 15 cm., where they end obtusely, 

 and 3 or 4 cm. beyond this in a direct line, resting upon the 

 anterior border of the broad ligament is the ovary, varying 

 in size according to the degree of disease. 



Prepare the ecraseur for use by withdrawing the chain 

 until the loop is barely of sufficient size to admit of its being 

 readily slipped over the ovary (or par-ovarian cyst as de- 

 scribed below) . Grasp this loop and the end of the ecraseur 

 tube in the hand, carry the instrument to the ovary or tu- 

 mor, and drop the loop over it from above. Pass some of 

 the fingers beneath the ovary or tumor, push it up through 

 the chain loop, and grasp it there with the thumb and index 

 finger. Holding the ovary with one hand, tighten the chain 

 quickly with the other, examine to make sure that a loop of 

 intestine is not caught, draw the ovary well through the 



