VA GINAL O VARIO TOM Y IN THE MARE. 1 1 3 



and forward movements, all four feet pinioned to the floor, 

 and the tail firmly secured and stretched to a beam above. 

 With soap, water and brush cleanse the tail, perineum and 

 vulva thoroughly, being especially careful to remove all 

 detachable masses of sebum ; 50 per cent, alcohol may be 

 used sparingly to aid in removing this. Too free a use of 

 alcohol excoriates the delicate skin. Cleanse the clitoris 

 carefully. Follow the washing with a free application of 

 I : 1000 aqueous sublimate solution. tO' the external parts and 

 for a short distance inside the vulvar lips and to the clitoris. 

 Do not introduce irritant disinfectants into the healthy 

 vagina nor deeply into the vulva as it may cau.se severe 

 straining during and subsequent to the operation and by in- 

 juring the vulvo-vaginal mucosa favor subsequent infection 

 of the vaginal wound. Wash away the sublimate with a 

 tepid .6 per cent, soda bicarbonate solution, and fill the 

 vulvo-vaginal canal with the same. After thorough dis- 

 infection of the hands and arms remove the disinfectants 

 by washing in sterile soda solution, which at the same time 

 renders the hand unctuous and readily introduced through 

 the vulva. Armed with the guarded sterilized scalpel, Fig, 

 II, introduce the right hand into the vagina promptly and 

 when it is well "ballooned " unsheath the knife and plac- 

 ing it just above the os uteri at I, Plate XVIII, parallel to 

 the long axis of the uterus and a few mm. to the right or 

 left of the median line, in order to avoid a loose fold of 

 mucous membrane generally existing =there, the blade be- 

 ing held vertical, that is the cutting surface parallel to the 

 longitudinal muscular fibers of the vagina, and guarding 

 the possible extent of its introduction with the thumb and 

 fingers, push it directly forward in a straight line with a 

 quick thrust through vaginal mucosa, the muscular walls 

 and the peritoneum, until the disappearance of resistance 

 indicates that the latter has been penetrated. This is the 

 most critical step in the operation. 



