504 
DEPARTMENT OF SURGERY. 
the sterile saline solution the vagina will generally be found 
u ballooned,” or will quickly become inflated under movements 
of the hand. If the solution is thrown out the vagina may 
collapse and closely invest the hand, in which case more soda 
solution should be injected, when it will again dilate. If the 
hand is introduced without the knife, withdrawn and then in¬ 
troduced with the knife it will be frequently found that the 
vagina has collapsed and needs a second filling with the fluid. 
Patience until dilation is accomplished and promptness to act 
when attained are prime requisites to success. The knife 
should be pushed through the vagina quickly, making a clean 
wound the width of the knife-blade, when the latter is to be 
withdrawn and laid aside. It should be remembered that in' 
this “ ballooned ” state the anterior wall of the vagina is but 
2 to 3 mm. thick and easily penetrated, the completion of the 
wound being indicated by the sudden disappearance of resist¬ 
ance. Introduce the hand again, insert one finger in the in¬ 
cision, then a second finger, and holding the fingers in the form 
of a cone, push the entire hand into the peritoneal cavity. Im¬ 
mediately belQw the incision and continuous with the tissues 
involved in the wound lies the uterus with a transverse diame¬ 
ter of 4 to 6 cm. With the palmar surface of the hand down¬ 
wards, trace the uterus forward a distance of 15 to 18 cm., 
where it ends abruptly in two cornua of about the same size as 
the uterus, which are given off horizontally at almost right 
angles. Trace these to right and left for a distance of 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 liga¬ 
ment is the dense oval ovary varying in size from 2.5 to 7 cm. 
in diameter. Withdrawing the hand, carry the ecraseur en¬ 
closed within the hand through the vaginal wound to the 
region of the ovary, release the ecraseur and retrace, the parts 
if necessary, and locating the ovary, drop the chain over the 
ovary from above and either grasp the ovary with the fingers 
through the chain loop from above and draw it into the loop 
or, passing one or two fingers around beneath the ovary, push 
it up through the loop to be grasped by the thumb and index 
finger above. The chain loop should be of barely sufficient 
size to admit of the easy passage of the ovary. Holding the 
ovary with the 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 and get'a large portion of 
the oviduct, and cut off promptly, holding to the ovary until 
