Excision of the Prolapsed Endocervical Fold 63 1 



base is readily accessible. The cervix is retracted into the 

 vaginal introitus and the inflamed fold is grasped with a 

 pair of tenaculum forceps, or, if the margin of this fold is 

 very ragged, a heavy pair of hemostats may be used, thus 

 straightening out the unevenness of the part and allowing a 

 straighter line of incision to be made through the mucosa 

 parallel to the forceps. The incision is best commenced on 

 the outer side of the fold and carried through the healthy 

 mucosa at the margin of the inflammatory area, making an 

 encircling incision through the mucous membrane at the 

 base of the piece to be removed. Then, incising a little at a 

 time, first on the outer, then on the inner side of the fold, 

 the point of the scalpel being directed towards its base, a 

 wedge-shaped piece of fibro-muscular cervical tissue is re- 

 moved. This leaves two free edges of mucous membrane 

 which are sutured together with No. or No. 1 chromatizecl 

 catgut, using an interrupted or running suture as conditions 

 may demand. Healing should occur by first intention. The 

 needle best adapted for this suturing is a %, or full-curved 

 cervix needle lVi to 1% inches long. Great care should be 

 used not to tear out the sutures, because their replacement 

 is very difficult and proper apposition of the margins is not 

 so readily attained. Often it is very helpful to place one 

 suture before the fold is completely removed, or, when re- 

 moving the fold, to catch up the free margins of the mucosa 

 with fine spring-catch cilia fixation forceps, thus keeping 

 the fine margins of mucosa readily available for suturing. 



Circular Amputation of the Cervix 



When disease of the cervix is of such character that one 

 of the previous methods can not satisfactorily remove the 

 inflamed tissue, it becomes necessary to establish by other 

 means a continuity of the healthy endocervical mucosa. 

 This may best be accomplished by a partial circular ampu- 

 tation of the cervix, including in the excision a varied por- 

 tion of the cervical fibro-muscular tissue along with the dis- 

 eased mucosa. This operation is extremely well adapted to 

 the correction of the large ectropic cervix (the so-called 



