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IffotraliM, of 
Surgery, Ooww^ Displacements. Stmgtwes, 
Fi stu las,^9®, Syphilis, Glanders etc. 
DESIGNED FOR READY REFERENCE BY 
AUTH © 2RL OF 
"Outline ChartsofRegional Anatomy" 
"The American Manikin" 
"Mammoth Dissecting. Plate" 
"Chart of Surgery" etc. 
"The utility of drawings in illustration of a purely demonstrative branch is now too well established to require any argument in its favor. Separated from the center of instruction, 
and deprived of the advantages of the dissecting-room, the ideas once so thoroughly acquired soon begin to fade, and the images, once so distinct, become confused and mixed. A recourse 
to plates, in the absence of dead bodies, is then the only means of refreshing our knowledge. Numerous works framed with these intentions have long enjoyed a large share of 
professional approbation."-Henry H. Smith. 
The claim of the present work is to have been selected from the most accurate of published works as well as from original drawings.- The Author. 
PUBLISHED BY 
The Cshimy 
PEOBXJl , ILL.. U.S. 
COPYRIGHT 1889 
By The American Manikin Company. 
PEORIA, ILL. 
[ HUGHES LITHO.CD.CHICAGO. | GENERAL REMARKS UPON INCISIONS. 
Incisions in the skin are made with the object of laying bare, 
or of removing some deeper part. 
They should be made sufficiently large, or the operation is 
rendered tedious and difficult. 
Incisions are made from without, inwards, as for the extirpation 
of a tumor, or from within, outwards, as laying open a fistula. 
In making incisions from without, inwards, the skin should be 
stretched upon the deeper parts by the left hand of the surgeon, 
or an assistant. 
Incisions from within, outwards, may be made with or without 
a grooved director. In one process, the knife being introduced in 
the second position beneath the skin, aponeurosis, or into a sinus, 
is raised to a perpendicular, and made to cut through the tissues 
from heel to point. 
In a second process, the knife being introduced in the first 
position, its point is made to perforate the tissues to the surface, 
and the cutting is effected from point to heel. By this second pro- 
cess a fold of skin may be cut through, as in the operation for 
strangulated hernia: a fold of integument is raised and held at one 
extremity by the operator, and at the other extremity by an assist- 
ant; the knife, held in the first position, is now made to pierce the 
fold and cut its way to the surface.- Norton s Text Book of Surgery. 
METHODS OF HOLDING THE BISTOURY. 
The three principal methods of holding the bistoury are seen in 
Plates I and IL 
The first position; for firmness and strength (Figs, i and 2, 
Plate I), the handle of the bistoury is held like a table knife with 
the edge turned downwards (Fig. 1), or with the edge turned up- 
wards (Fig 2). 
The second position (Figs. 3 and 4), for lightness and precision, 
the bistoury is held like a pen, with the edge turned downwards 
(Fig. 3), or upwards, as in Fig. 4. Plate L 
FIG.2. 
FI6.3.] 
k FIG.^-. Plate II. 
The third position (Plate II, Figs, i and 2) is for nicety and precaution. The 
bistoury is held like the bow of a violin, with the handle of the instrument held 
forwards, the blade backwards, and the cutting edge upwards (Fig. 1), or else with 
the handle backwards, the blade forwards, and the edge downwards (Fig. 2). 
The various positions for holding the bistoury, as illustrated in Plates I and II, 
are merely suggestive ; the experienced surgeon will choose for himself. 
TYING AN ARTERY IN A STUMP. 
Figure 3.-a. Artery in a stump, seized on the point b, of a tenaculum; c, c, 
are ligatures for tying the artery. Plate H ORDINARY PROCEDURES IN LIGATING AN ARTERY. 
In order to find an artery which it is intended to tie - 
Firstly.- Determine the course of the vessel, both by anatomi- 
cal knowledge and by the pulsation of the vessel. 
Secondly.- The skin being conveniently stretched, make an in- 
cision with a convex bistoury'', held in the third position, along the 
course of the vessel, increasing the length of the incision according 
to the depth of the vessel. 
This incision should comprise the skin and the cellular tissue. 
Thirdly.- Divide by means of the grooved director the envel- 
oping aponeurosis, and turn aside the muscles to seek the vessel, 
which is usually contained, together with its companion veins and 
nerves, in a common sheath. 
Fourthly.- Raise the sheath with dissecting forceps, and divide 
it with precaution, sufficient only to introduce an aneurism needle. 
Fifthly.- Next lay aside the bistoury, and with the director 
and forceps free the vessel from the tissue around, taking care not 
to denude the vessel to too great an extent, and also to introduce 
the director between the vessel and the most important companion 
structure,, in order not to wound that structure by the point of the 
director. 
Sixthly.-When the artery is denuded and raised upon the direc- 
tor, determine the pulsation, and then pass the ligature beneath it 
by means of an aneurism needle furnished with the thread, intro- 
ducing the needle between the artery and the most important 
companion structure. 
Seventhly, and lastly.- Tie the artery tightly in the first knot, 
drawing the thread over the two index fingers like pulleys, in order 
to prevent too great an elevation, and a too great traction upon 
the artery; then tie the second knot, and cut one end of the 
ligature, bringing the other out at the lower end of the wound, 
unless the catgut ligature is employed, in which case both ends are 
cut off short.- Norton. 
PLATE III. 
LIGATION OF THE AXILLARY ARTERY IN ITS .LOWER THIRD. 
References.-a, Incision of the skin ; b, division of the apon- 
eurosis ; c, median nerve; d, axillary vein pressed downwards by 
the retractor; e, internal cutaneous nerve ; f sheath of the axillary 
vessels ; g, axillary artery upon the director. Plate MT Plate IV. 
FIG. 1.-OPERATION FOR TRACHEOTOMY. 
a, a, Incision in the middle line front of the trachea; b, b, tape to keep canula 
in the trachea. 
FIGS. 2, 3 AND 4.--DISARTICULATION OF FINGER AT 
SECOND JOINT BY DORSAL INCISION. 
First stage.- The Joint entered by the blade of the knife (Fig. 2). 
Second stage.- After having traversed the articulation, the knife is turned down 
beneath the bone, and brought out on the palmar surface, in order to cut the flap 
(Fig- 3)- 
Third stage, and operation completed.- Flap applied to the stump by adhesive 
plaster. Instead of employing plaster, the edges of the flap may be adjusted by 
sutures. Plate W 
F1G.1. 
£ FIG. 2. 
I FIG.3. 
, FI6.^. Plate V. 
DISARTICULATION OF THE METACARPAL BONE 
OF THE THUMB. 
Figure i.- a, b, c, Form ot incision. 
Figure 2.- The thumb being drawn across the palm of the hand, the dis- 
articulation of the base, a, of its metacarpal bone is accomplished. 
Figure 3.- Lips of the wound adapted. Plate V 
^FIG.Q 
FIG, 2. 
FI 6.3. Plate VI. 
HARE-LIP. 
Figure i.- Simple Hare-lip. 
Figure 2. - The same after operation. 
Three points of twisted suture unite the edges of the wound. Plate AT 
[figx 
FIG. 2. Plate VII. 
Figure i.- Double Hare-lip. 
Figure 2.- The same after operation. Plate VII 
FIGJj 
FIG. 2. Plate VIII. 
OPERATIONS UPON THE EYE. 
Figure i.-Ectropion-Desmarres Operation.-a, b, First incision 
beginning at the external angle of the eye; b, c, second incision 
beginning at the free border of the lower lid and joining the first 
at b ; c, d and a, d, two incisions beginning at the internal extremities 
of the two first and meeting at d, at the point of reflection of 
the ocular and palpebral mucous membranes. 
Figure 2.- Same operation finished.- Three sutures, ay a, a, 
uniting the edges of the wound. 
Figures 3 and 4.- Adhesion of the Lid to the Globe of the Eye 
(Symblepharon). 
Figure 3.- Ammons Operation.- The portion of the eyelid 
which adheres to the globe of the eye is enclosed between two 
incisions, a, b and c, b, which isolate it from the rest of the eyelid. 
Figure 4.- Same operation finished.- The two free edges of 
the incision are united by three sutures; a, the little adherent flap. 
Figures 5 and 6.- Operation for Strabismus - M. Sedillot's 
plan. Fig. 5.- The lids are kept away by a blepharectome, a; b, a 
tenaculum entrusted to an assistant; c, forceps raising a fold of 
conjunctiva; d, scissors cutting the fold in order to expose the 
muscle. Fig. 6.- a, The blunt hook passed beneath the muscle; 
b, the scissors cutting through the internal rectus muscle. Plate Vin 
2222^ 
FIG.'E 
FIG.1 
. FI6.3. Plate IX. 
RHINOPLASTY. 
Rhinoplasty originated in India, where the Brahmins sometimes employed it to 
remedy the deformities which had been caused by punishment for crime. About 
the fifteenth century it was introduced into Italy, and established as a regular 
operation by Branca and Tagliacozzi. 
The object is to repair a partial or total loss of the nose. 
The Indian method consists in taking from the patient's forehead sufficient skin 
to repair the loss of tissue (see Plate IX).- Norton. Plate IX 
RHINOPLASTY. Plate X. 
RHINOPLASTY. 
The Italian method is but a modified form of the operation per- 
formed in Italy by Tagliacozzi. The new nose is borrowed from 
the skin of the arm. 
The figure (Plate X) shows the kind of bandage which the 
patient will have to make up his mind to endure while the arm is 
kept up to the face. 
Remarks.- Rhinoplasty is always a serious undertaking. It 
rarely affords encouraging results, and noses formed in this way 
often shrivel up and form tubercles, which sometimes result in a 
deformity more hideous than that which it has been intended to 
cure. Nowadays, such successful noses have been made of wax 
and other materials, and attached by means of spectacles, etc., that 
it is only in extreme cases that rhinoplasty is employed, and the 
surgeon should not yield to his patient's request until he has 
warned him of the dangers to which the operation will expose him. 
Few people will endure the Italian operation. In most cases the 
Indian plan is preferable.- Norton. Plate X Plate XI. 
SECTION OF TENDO-ACHILLES TALIPES EQUINUS. 
The foot is in the same line as the leg, and only the toes rest on the ground 
(see Fig. i). The heel is raised by the contraction of the tendo-achilles; a, point 
of puncture of the 'skin where the tendon is to be cut. 
Fig. 2 shows position of surgeon and his assistant. The tenotome, b, intro- 
duced by the wound, a, dividing the tendon from behind, forwards. 
Fig. 3 shows a dissection of the parts, so that the divided tendon may be seen 
at a, a; b, sheath of the tendon ; c, the crural aponeurosis which forms the pos- 
terior layer of the sheath of the tendo-achilles ; d, division of the skin. Plate XI 
>FI63-< 
FIG. 1. Plate XII. 
ANAL FISTULA. 
Figure i .- Blind Internal Fistula.- a, b, Fistula ; a, internal 
orifice communicating with the interior of the bowel, d; b, blind end 
of the fistula ; c, anus ; f section of .tissues between the fistula and 
the bowel 
Figure 2.- Complete Simple Fistula.- a, b. Fistula tract, open- 
ing at a, in the intestine, and at b, near the anus, c; f section of 
intervening tissues. 
Figures 3 and 4.- Desault's Method of Operating,- K grooved 
director, a, 6, c, passed through the fistula, is caught by an instru- 
ment, d, introduced into the intestine. A bistoury', e, is started in 
the groove of the director to divide the bridge of tissues, f. 
Figure 4.- The same operation.-The bistoury, e, meets the in- 
strument, d, at the end of the director, c, and both bistoury and 
instrument are drawn out together to divide the soft parts in the 
angle made by the instruments. 
In the ordinary operation, a grooved director is passed through 
the fistula, and caught by the index finger of the operator, and 
brought to the outside of the anus, as seen in Fig. 5 ; g, the direc- 
tor ; a, b, the fistula; e, blade of the bistoury lodged in the groove 
of the director g, d ; this blade traveling along the director will 
divide the bridge of tissues, f. 
Figure 6.-Ligahtre.- A thread introduced into the fistula, b, a, 
reaches the intestine, d, and passing out by the anus, includes the 
tissues, f, in a loop. Plate XII 
[FIG.3.1 
FISTULA IN ANO. 
Fl 
FIG.6. Plate XIII. 
HERNIA. 
Division of the Stricture.- Figure i.- A fold of skin is raised 
over the tumor, transversely to the axis of the groin. This fold of 
skin is held on the inside by an assistant, and on the outside by 
the left hand of the operator, who, with his right hand, cautiously 
makes an incision into the fold. The incision may be made from 
within, outwards, by plunging the instrument, with its sharp edge 
upwards, into the base of the fold. The above incision (Fig. 1) 
has merely involved the skin and subcutaneous cellular tissue. 
When the edges of the wround are separated, the swelling, a 
(Fig 2), is exposed enveloped in its several coverings, which are 
next divided, layer by layer, with the bistoury, b, guided over a 
director, c. 
The hernia is now exposed. 
A director, or the finger, is inserted between the hernia and 
the seat of stricture. 
Figure 3.- The Division of the Stricture.-The surgeon passes 
over a finger of the left hand either a hernia knife, or a blunt 
pointed bistoury, the blade of which has been partially covered with 
lint, and then proceeds to divide the stricture. Plate XIH 
FIG.2J 
FIGI^ 
LH6.3.J Plate XIV. 
WOUNDS OF THE INTESTINE. 
Figure i.- M. Gelys Quilted Suture.- The surgeon takes a 
silk thread that is well waxed and armed with a needle at each end. 
One of the needles is passed through point b, above, and one-sixth 
inch external to the upper angle of the wound, and is brought out 
from within, outwards, at point c. one-quarter inch below. The second 
needle enters at point b, and comes out at point c. The figure illus- 
trates this first step of the operation. 
The ends, a, a, of the thread are. then crossed in front of the 
wound in such a manner that the thread from point c re-enters at c, 
and the thread from point c re-enters at c. The needles then make 
their exit at d and d'. Another crossing of the threads is made, that 
issuing from d' re-enters the bowel at d, as was done above at c and c. 
This proceeding is continued as far as one-sixth of an inch below the 
wound, where the threads are tied in a knot. 
' I 
Figure 2.- M. Reybard's Operation.- The illustration shows a 
transverse section of the bowel, and of the abdominal wall on a level 
with the wound; a, a, wall of the abdomen ; b, b, b, bowel; c, tablet 
introduced into the bowel; d, d, d, suture of thread passing through 
and keeping in apposition the tablet, the bowel, and the abdominal wall. 
Figure 3.- Transverse Wound of the Bowel-M. Jobert's Oper- 
ation- Apposition of the Serous Surfaces.- Two silk threads, a, a and 
b> perforate the upper end of the bowel. At the lower end, the edge 
of the bowel has been turned inwards, while the thread, provided with 
a needle at each end, passes through this inverted edge and maintains 
the inversions. 
When traction is made upon the threads, a and b, the upper end 
of the bowel is invaginated within the ^wer portions, and by this 
means the serous surfaces are brought into contact. 
Figures 4 and 4%.- M. Lembert's Operation.- The number 
of needles and thread required in this operation must be in proportion 
to the number of sutures to be applied. One thread, a, is inserted at 
d, and drawn out at b; it then passes over the transverse wound, re- 
enters the bowel at b, and again makes its exit at c. 
The other threads are applied in the same manner. 
Figure 4 bis represents the course of the thread, a, b, c, d, e, 
through the wall of the abdomen, A. It is only necessary to pull the 
thread and to tie it, in order to bring the serous surface of the edges 
of the wound into contact with each other, B. 
Figure 5.- M. Amussat's Operation.- Longitudinal section of 
the bowels, showing the cork, a, a, over which the two ends of the 
bowel are bound by the thread, b, b, the mucous surface of one end 
being brought into contact with the serous surface of the other. 
Figure 6.- Denaris Operation.- Longitudinal section of the 
bowel and of the collars or rings, showing the disposition of the 
apparatus employed: a, central collar; b, b, the two eccentric collars, 
less deep, but broader than the central one, a. One thread d, d, d, d, 
f fl g, keeps it all in position. The edge of the upper portion of 
bowel, c, is folded round the upper collar, b, and that of the lower 
portion, c, is folded in the same manner over the other collar, b. The 
central collar, a, keeps the edges of the wound inverted and presses 
them against the internal surface of the two collars, b, b. By this 
means the serous surfaces of the intestinal wall are brought into con- 
tact. The thread, d, dff f g, keeps the collars in place. 
Remarks.- The operations above described have not all been 
performed.-Norton's Text Book of Operative Surgery. Plate XB 
* fig e 
fig^^ 
[ FIG.1J Plate XV. 
OPERATIONS UPON THE PENIS. 
Figure i.- Division of the fraenum. 
Figure 2.- Phimosis-First stage of operation; 
Figure 3.- Phimosis - Second stage of operation. 
Figure 4.- Circumcision - First step. 
(For continuation see Plate XVI.) Plate XV 
FIS.'*. Plate XVI. 
OPERATIONS UPON THE PENIS-Continued. 
Figure i.- Circumcision - Second step. 
Figure 2.- Circumcision - Third step. 
Figure 3.- Circumcision - Showing sutures. 
Figure; 4.- Operation for Paraphimosis - Reduction. Plate XVI 
FIG.2. 
' FIB.1.; 
FIG.4-. Plate XVII. 
OPERATIONS UPON THE PENIS-Continued. 
False Passages - Stricture of Urethra-Plastic Operations - Enlargement 
of Meatus - Fixing Instruments in Urethra. 
Figure i.- Accidents of Catheterization. 
Figure 2.- Passage of bougies through stricture. 
Figure 3- Cauterization of the prostatic part of the urethra with M. Lalle- 
mand's instrument. 
Figure 4.- Cauterization of the membranous part of the urethra with the 
straight instrument. 
Figure 5.- Division of stricture. 
(Continued in Plate XVIII.) Plate MI 
FI 
F l 3 ? 
eTgXI 
FI6T4. ] 
FIG.5. Plate XVIII. 
OPERATIONS UPON THE PENIS-Continued. 
Figure i.- Antero-posterior section, showing a stricture of urethra. 
Figure 2.- Plastic operation. 
/ 
Figure 3.- Operation by lateral incision. 
Figure 4.- Enlargement of meatus. 
* 
Figure 5.- Urethra ending in two aperatures on the glans, a and a. 
Figure 6.- A catheter fixed in urethra by a piece of darning cotton tied around 
the penis behind the corona. Plate M 
FIG.1. 
>16.2?) 
"fig. 3? 
?h6.<> 
FIG. 5. 
FIG. 6.? Plate XIX. 
GLANDERS-EQUINIA. 
Glanders is a disease peculiarly appertaining to the horse, con- 
sisting of a specific poison which is highly contagious and capable 
of being communicated to the human species through the medium 
of inoculation. Dr. Elliotson was the first to accurately describe the 
disease in man, and he termed it equinia, as proceeding from the 
horse. The disease in man manifests itself much the same as in 
the horse, viz.: as glanders or farcy. ' The duration of the disease 
varies ; in the actitest form it is fatal within a week, and death has 
taken place even within three days; in others it has lasted three or 
four weeks, and in some rare instances, life has been prolonged for 
many months. 
In man, as well as in the horse, the disease arises from con- 
tagion, and the most common medium is the nasal discharge and the 
discharge from farcy swellings. 
It may be spontaneously developed in the horse, but never is 
in man; but once communicated by the horse to man, it can be 
communicated from man to man. 
Although the virus must come in direct contact with a wound 
or abraded surface, yet cases are recorded in which the disease 
was produced by wiping the face with unclean hands or cloths.- 
Holmes. 'Plate XIX 
GLANDERS BY INOCULATION. Plate XX. 
SYPHILIS. 
When syphilitic matter is applied to the surface of the human 
body no appreciable effect in general results; but when the poison 
comes in contact with the thin skin in those situations where it joins 
the mucous membrane, or when applied to the mucous membrane 
itself, or to the skin in places where the epithelium has been 
removed, then inoculation may take place. When artificially inocu- 
lated, the inoculated point becomes red within the first twenty-four 
hours. From the second to the third day it becomes slightly raised, 
and is surrounded by a red areola. Between the third and fourth 
day it contains a fluid more or less turbid. From the fourth to the 
fifth day the pustule becomes fully formed, and from this time to 
the termination of the disease, the secretion consists of well-formed 
pus. As soon as suppuration commences, there is loss of substance 
in the part and an ulcer forms, which has peculiar characters. 
When not interfered with by any accidental causes, it increases 
equally in every direction, so as to form a more or less perfect 
circle. The edges of the ulcer are cleanly cut and present a sharp 
outline (see Plate XX, Fig. i).- Holmes. 
Figure i.- Inoculations from a suppurating sore as they ap- 
peared on the forty-first day. 
Figure 2.- Sloughing of indurated sore.- Cullerier. 
Figure 3.-Inoculated syphilis on the hand of a surgeon -Holmes. Plate XX 
SY PH I LIS. 
FI 6.1^ 
FIG. 2.j 
Indurated Chancres^ 
from Vaccination. I 
Vaccination sores ' 
healed, then came 
the Chancres. Plate XXI. 
SYPHILIS. 
A case of chancroid phimosis, accompanied with gangrenous bubo. Plate XXI 
SYPHI LI 8. 
Gangrenous ' 
bubo. 
bubo. 
f Chancroid 
'Phimosis Plate XXII. 
SYPHILIS. 
Case of a healthy married woman who took a strange child to nurse in addition 
to her own. The strange child proved to be syphilitic. The woman had an ulcer 
on the breast, followed by a well-marked general syphlitic eruption (see figure). Plate XXII 
SYPHILIDE. 
ne result of nursing a syphilitic child. Plate XXIII. 
SECONDARY SYPHILITIC ERUPTIONS AND ULCERATIONS. 
From some peculiarity in the patient's constitution, or from some want of 
power in carrying out the natural processes of the disease, the syphilitic eruption may 
be accompanied by an effusion of serum only. 
The diseases thus produced have received a variety of names, according as 
they have resembled other diseases, of the skin. Thus we have described syphilitic 
turpes, syphilitic eczema, the varicelloid syphilitic eruption, the impetiginous syphilitic 
eczema, etc. ; these are all accidental modifications, and do not require any separate 
or distinct mode of treatment.- Holmes. Plate XXIII 
Moist 
Papule s.'': 
SYPHILIDE. 1 ' L AT E X X I V. 
SECONDARY SYPHILIS. 
Condylomatous vegetations about the vulva.- From Bumstead. Plate XXIV 
SYPHILITIC VEGETATIONS. Plate XXV. 
ANATOMY. 
Bloodvessels of the Female Pelvis (side view).- Bour gery and facob. 
Explanation.- u t, Uterus; utr, uterine artery; B, bladder; Vg, vagina. Plate XXV Plate XXVI. 
ANATOMY. 
Bloodvessels of Pelvis (front view),- Bourgery and Jacob.- This plate repre- 
sents the anterior part of the bony pelvis as having been removed, the top of the 
bladder cut away, as also part of the anterior vaginal wall, a o, The abdominal 
aorta dividing into the common jliacs, and then again into the external and internal 
iliacs ; B, bladder; r, rectum ; u t, anterior surface of uterus ; f t, fallopian tube ; 
C, cervix uteri (vaginal portion); g, corpus cavernosum of clitoris ; r I round liga- 
ment; utr, uterine artery crossing the ureter, u; V, vagina. 
In this pelvis the uterus is drawn up, and the fallopian tubes attached to the 
iliac fossa in order to show them. Plate XXVI FLATE AAV11. 
OPERATIONS FOR PROLAPSE OF THE WOMB AND UTERINE POLYPI. 
Figure i.-Prolapse of the Uterus and Vagina.- u, Meatus; 
ly I, labia majora; a, vagina drawn outwards by the uterus between 
the labia majora; the mouth of the uterus, b, is seen externally; 
p, the anus. 
Figure 2.- Obliteration of the Vagina.- prolapsed ; 
b, mouth of the uterus; p, anus; I, I, labia; u, meatus; 5; 5, internal 
surface of the labia majora pared at the level of the vaginal orifice; 
c, c, c, loops of suture which traverse the labia at the level of the 
pared portion, and of which the ends, d, d, d, are seen on the 
opposite side. 
Figure 3.- Operation Completed.- I, I, Anterior portion of the 
labia majora; p, anus; B,B, quills engaged on the one side in the 
loops of the sutures, c, c, c, and over which, on the other side, the 
ends, d, d, d, are tied. 
Figure 4.- Ligature of a Polypus.- a, Polypus; b, gorget held 
by an assistant to separate the polypus from the vaginal wall and 
help the action of vulsellum forceps, d, and at the same time to 
facilitate the passage of the ligature, carried round the pedicle, c, 
by the knot fastener; u, the meatus urinarius; b, fingers of an 
assistant; p, anus. 
Figure 5.- Excision of a Polypus.-a, Polypus; p, anus; Z, I, 
labia separated by an assistant, b, b; u, meatus; t, t, tenaculum 
forceps which draw upon the polypus, the pedicle of which is partly 
cut through by strong scissors.- Norton. Plate TOH 
[figj. 
FIG.2 
FIG.3. 
FIG.5. Plate XXVIII. 
Figure i.- Pedicuiated Polypi.- Boivin et Duges. 
Figure 2.- Fissure of os uteri. 
Figure 3.- Vesicular polypi. Plate XW111 
FIG.2.^ 
■ FIG.1J 
FI6.3., Plate XXIX. 
INVERSION OF THE UTERUS. 
This dangerous but not very frequent form of displacement consists in the 
turning of the uterus inside out As the bottom of a bag may be pushed through 
its mouth so that the inner surface becomes the outer, so may that of the uterus, and 
the occurrence of such an accident constitutes the condition which is here portrayed. 
The causes of this condition are - 
First.- Relaxation and inertia of the uterine walls. 
Second.- Downward traction or pressure. Should inversion occur suddenly, as 
after delivery, the patient will complain of discomfort about the vulva, with faint- 
ness and nervous disturbance. Hemorrhage and tendency to collapse will show 
themselves, and unless proper treatment be adopted at an early period, death may 
ensue. The treatment should be to first control the hemorrhage by hemostatic 
means, and then reduce the inversion bv taxis and elastic vaginal nressure.- Thomas. Plate XXIX 
INVERSIO UTERI.(Boivin) Plate XXX. 
Cancer of the uterus, posterior vaginal wall and rectum.- Bowin and Duges. Plate XXX 
CANCER OFUTERUS 
ANO RECTUM