Incision. —If large-sized blood-tumors remain unchanged for a long time, and give rise to much pain; or if febrile symptoms appear, a free opening of the mass is proper, so as to permit of complete outflow. With full antiseptic precautions, incision is probably not as dangerous as it once was. The vagina must first be disinfected, and the relation of the tumor to the neighboring parts be ascertained, so as not to unnecessarily destroy tissue, or perhaps endanger the rectum. Not infrequently we will find at the lower portion of the tumor, somewhere in the posterior vaginal vault, a soft and thin spot at which opening can best be done. If the vaginal arteries are wounded, there may be serious hemorrhage; and it is advisable to search for their pulsation at the preliminary exami nation, and to locate them exactly. The incision can be best made when the parts have been exposed by a Sims speculum; an ordinary sharp and probe-pointed bistoury are all the instruments that are necessary. The cut is preferably made in a sagittal direction, since thus the vaginal arter ies are most likely to be avoided. If the contents of the sac are foul, they must be carefully emptied out, the cavity cleansed with some disinfecting solution (2 per cent. carbolic acid sol.), and a drainage tube put in.
-In five cases, of which four were successful, Zweifel opened blood tumors situated behind the uterus in two stages, so as to avoid hemor rhage. After introducing a speculum he first cut through the vaginal wall; and when the bleeding had stopped, he tore the edges apart with a pair of Muzeaux's scissors, and with his finger denuded the wall of the tumor. Then he incised the mass, and dilated the incision with Simp son's covered metrotome No. 2, to the breadth of three fingers. With the help of a self-retaining drainage tube he kept the cavity nearly con stantly irrigated. In the first eases he washed the wound out every two to three hours with carbolic acid solution; in the later cases he added iodoform, which he highly recommends. In spite of the use of Munde's blunt curette, the evacuation of blood clots is not always completely suc cessful. In his last edition Zweifel criticises the method, as well as A. Martin's plan " to introduce laparotomy for blood-tumors." We will consider it when we come to the subject of hematoma peri-uterinum