406 Diseases of the Genital Organs 



against the operator's hand, grasps the ovary, and exerts 

 the degree of pressure required to rupture the cyst. The 

 vaginal wall will withstand securely the maximum digital 

 compression, if prudently applied, which a powerful man 

 can exert. 



Sometimes the cyst wall is so dense and resistant that, 

 however powerful the man may be, he can not rupture the 

 cyst by digital compression. If, after a reasonable effort, 

 it is not ruptured, it is best to desist and resort to the easier 

 and safer operation in such cases, of stabbing the cyst and 

 thus evacuating its contents. The operator, if right-handed, 

 inserts his right hand into the rectum, grasps the cystic 

 ovary, and draws it back over the vagina. The left hand is 

 then inserted into the vagina and a secure hold upon the 

 ovary obtained by passing the hand forward with the palm 

 downward, the index finger passing to the left of the gland 



Fig. 129a — Ovarian Scalpel 



and the thumb to the right. The ovary is then pressed down 

 with the right hand between the thumb and finger of the 

 left hand, and the broad ligament beyond the ovary securely 

 grasped so that the ovary with the cyst rests in the palm of 

 the hand. The right hand is then withdrawn from the rec- 

 tum and an attendant quickly washes off the feces. The 

 ovarian scalpel (Fig. 129a) is grasped and, guarded, is 

 pushed carefully along the forearm and palm of the left 

 hand until the end of the blade is against the vaginal wall 

 over the center of the cyst. When sure that the end of the 

 scalpel is properly placed and directed toward the center of 

 the cyst, the guard is released and the scalpel given a quick 

 thrust forward through the vaginal wall and the wall of the 

 cyst. The moment the scalpel enters the cyst, the latter col- 

 lapses. The scalpel is then withdrawn and the pressure 

 continued upon the cyst until its contents are fully evacu- 

 ated. Care should be taken, when grasping the ovary from 



