684 Veierifiarv Obstetrics 



the cervix uteri, while others contend that it has no real value. 

 With this latter opinion we are in full accord. 



A more hopeful class of drugs, which we do not know to have 

 yet been used, are the local anaesthetics. Stovaine, we know, 

 induces marked muscular paralysis when injected upon a motor 

 nerve. Cocaine and eucaine would probably prove serviceable 

 but must be used with caution, lest poisoning follow. These 

 may prove highly important in combination with mechanical 

 dilation. 



The mechanical dilation of the canal is that to which final 

 resort must be made. This frequently constitutes a very trying 

 ordeal, which may require much labor and patience. For this 

 purpose the vagina and vulva should be well disinfected and the 

 hand rendered unctuous by means of an aseptic or antiseptic oil 

 or fat or by keeping it well moistened by means of a warm lysol 

 solution. By passing the hand through the vagina to the os 

 uteri, one, two or more fingers are pressed through the os. As 

 the OS becomes somewhat dilated, the fingers are held in the form 

 of a cone and, by a .somewhat rotary motion, are forced further 

 and further into the cervix, until finally the hand is pushed 

 through into the uterine cavity, when a portion of the fetus may 

 be grasped and secured, and the dilation completed from in front 

 by drawing upon the fetus itself. 



It should be constantly remembered that the mo.st effective 

 direction for the application of the force is from in front, as in 

 normal parturition, and consequently, the earlier we can apply it 

 from this direction the better, and the easier the task. 



In one instance we were without mechanical appliances for 

 dilating the canal, except obstetric instruments which were 

 armed with olive-shaped handles tapering from the butt toward 

 the point. After dilating the canal sufficiently to push one of 

 these instruments through until the handle entered the uterus, 

 we then introduced a second handle along the shank of the first 

 instrument and forced it through also. Drawing simultaneou-sl}^ 

 upon the two instruments brought the two handles together at 

 the anterior opening of the cervix, and thus forced the cervical 

 walls apart and dilated the canal far more effectively than we 

 could have done by force applied from behind. 



Uterine dilators are made, which in our experience po.s.sess high 

 efficiency and greatly lighten the labor of the mechanical dilation 



