File:Interstate medical journal (1917) (14597224157).jpg

Identifier: interstatemedica2419unse (find matches)
Title: Interstate medical journal
Year: 1917 (1910s)
Authors:
Subjects: Medicine
Publisher: St. Louis, : Interstate Medical Journal
Contributing Library: The College of Physicians of Philadelphia Historical Medical Library
Digitizing Sponsor: The College of Physicians of Philadelphia and the National Endowment for the Humanities

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Cervix and uterus.—Ordinarily the cervix may be graspedwithout producing pain; however, many patients do complainof pain when this procedure is attempted. It has, therefore, beenmy practice to produce a wheal before the cervix is grasped by thetenaculum (Fig. 8-B). The technic for rendering the cervix anduterine mucosa anesthetic is as follows: With a four-inch needle(Fig. 9) a wheal is made to the right or left of the cervix. Theneedle is then advanced from 1.5 to 2 inches parallel to the midlineof the uterus, traction being made on the cervix the while. Asthe needle is withdrawn the fluid is allowed to escape into the para-metrium. The. direction of the needle is changed with each stroke,and an effort made to inject the tissues to the side of the uterus, one-half to three-fourths of an ounce of novocain being used. Thisprocedure is repeated on the opposite side, when dilatation of thecervix may be begun. In from five to ten minutes painless curettage 666 INTERSTATE MEDICAL JOURNAL
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Farr: Vaginal Operations Under Local Anesthesia 667 may be accomplished. For amputation of the cervix a ring is in-filtrated around the cervix in the vaginal vault, this infiltrationbeing allowed to extend well into the tissues of the cervix throughoutthe entire circumference (Fig. 8-B and Fig. 10). Hysterectomy.—My experience in the performance of vaginalhysterectomy is limited, as I much prefer the abdominal route forthis work; however, we occasionally see elderly patients with uterineprolapse and ulceration of the cervix and the vaginal wall which Fig-. 12.—Pneumatic injector. For the introduction of local anesthetic solutions. condition, in the absence of malignancy, is best handled by a vaginaloperation. When necessary, this operation is preceded by a pre-liminary injection about the introitus (Fig. 5), as in the operationspreviously described. The area in the vaginal vault to be incisedis outlined by a line of infiltration (Figs. 8-B and 10), the cervixin grasped with a tena

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