Identifier: gynecologygrav (find matches)
Title: Gynecology :
Year: 1918 (1910s)
Authors: Graves, William Phillips, 1870-1933
Subjects: Gynecology Genital Diseases, Female Women Gynecology
Publisher: Philadelphia : Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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t to avoidtearing into it in the process of stripping out the cervix. A sound is first passedto determine the depth of the uterus and cervix and to ascertain approximatelythe level of the internal os. A sound is then passed through the urethra intothe bladder fold, where it is reflected from the cervix. This fold is usually foundon the anterior wall of the cervix very near the external os, and a knowledge ofits exact position is very important. 600 GYNECOLOGY Traction hooks are then placed one at each corner of the tear and one in themiddle of the cervix, including both lips and sealing the opening, so as to avoidthe expulsion of any endocervical discharge during the operation. With the cervix held out in strong traction a circular incision is made justbeyond the reflection of the bladder fold. The assistant exercises counter-traction on the vaginal mucous membrane, and the circular dissection is carriedout with a knife until the small tubular core of the cervix is reached, great care
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Fig. 233.—Amputation of the Cervix. The cervix has been drawn well out from the vagina. The cervix is being circumcised at (the junction of the bladder with the portio vaginalis. being taken not to injure the bladder fold. The fold of Douglas pouch on theposterior wall of the cervix is usually not in danger in this dissection, as it isattached higher up than the bladder. After the core of cervix is reached itwill be found that the tissue of the uterine wall can easily be stripped back fromit by-gauze dissection (Fig. 233), the knife being occasionally necessary to sever OPERATIONS ON THE CERVIX 601 especially resistant connective-tissue fibers. This dissection is carried to withina short distance of the internal os, as determined by the length of thecervix pre-viously ascertained. The two traction forceps, are then inserted in the sides ofthe cervical tube close to the limit of the dissection, and held by the assistants.The cervix is drawn strongly outward by the remaining traction

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