V 
312 F. S. BILLINGS. 
quantitive decrease of the milk. In forthcoming cases I shall uncon¬ 
ditionally follow the above method of Putz, as my suspicion proved 
itself unfounded, and the method being the simplest of all, giving smooth 
traumatic surface and being the easiest of execution. I was not suc¬ 
cessful in fixing the ligamenta with the hands in any case without pre¬ 
viously cutting into them laterally. The torsion with the forceps has 
the disadvantage that severe disturbances with fatal endings can easily 
take place, and the cutting of the ligaments has convinced me that this 
is the best method. The forceps of Richter are too short to operate 
advantageously. They do not correspond to the length of the vagina, 
and favor thereby the entrance of air. The torsion forceps are, also, 
too weak, and not capable of offering resistance enough to the strong 
ligaments, thereby retarding the torsion. The straight bistoury with a 
leather cup is disadvantageous, in that the operator easily injures the 
balls of his hands in the removal of the same, and the retention of the 
same in the hand after baring the blade renders the holding of the 
transverse fold with fingers difficult. I used a bistoury-cache, 35 ctm. 
long (14 inches.) With the latter and Richter’s forceps the operation 
is very easy, and surely and rapidly performed in the following manner: 
The animal should be bound short; three or four assistants should be at 
hand, one to hold the head, another to stand at the side in order to ob¬ 
viate lateral movements as well as arching of the back during the op¬ 
eration ; the third should hold the tail to one side and attend with the 
instrument. The operator should moisten his hands and arms with 
warm water (oil is not conformable, rendering the holding of the trans¬ 
verse fold and instrument difficult), and introduce them (the left hand 
and arm) into the vagina; he then forms a transform fold in the superior 
vaginal parietes in the median line of the vagina, and immediately pos¬ 
terior to the orificium uteri ex., and draws the fold downwards ; the 
thumb, first and second finger are to be used to form the fold. The op¬ 
erator then enters the withdrawn bistoury, following along the left arm, 
places the anterior end upon the thumb and against the posterior sur¬ 
face of the transverse fold ; he then pushes the blade of the bistoury out 
by means of the button at its posterior end, with the thumb of the right 
hand, the fold being concomitantly punctured at its basis ; the operator 
holding the fold firmly with left hand, he then uses the' first and second 
fingers, passes them over the bistoury and presses it directly downwards, 
or presses the fold upwards, at the same time drawing the blade down¬ 
wards and cutting at the same time. Is the vaginotomy successful, of 
which we can easily convince ourselves, with a finger of the left hand, 
