In case peri-uterine adhesions or inflammatory affections are present, we must resort to the method with the greatest care, possibly limit it to simple fixation of the uterus. Acute inflammatory processes are contra indications, as also pregnancy, when the hemorrhage from the cervix may be quite profuse.
When the examination is ended the tenacula are removed with care in order not to injure the cervix or wound the patient. In case the cervix was soft or vascular, or it has been damaged by the tenacula, then it may bleed quite freely. The bleeding points may be touched with lunar caus tic, or else, and this is preferable, superficial sutures may be inserted, under the usual antiseptic precautions.
Dislocation of the cervix with the tenaculum is also useful in the reposition of the retro-flexed uterus, and I have for long thus used and demonstrated it with good results. The tenaculum, further, is used dur ing a number of procedures, such as curetting, making applications, the insertion of tents, stems, etc. Still further elastic traction may be ex erted for the purpose of rendering the uterus more movable, the adapta tion of denuded surfaces, etc.
Originally I resorted to elastic traction in the treatment of parametritio remnants which would not yield to pressure exerted by pessaries, the traction being made in the axis of the pelvis or as nearly as possible at right angles to it. By means of it, also, I have often obtained good re sults in case of rigid vagina as a preparatory measure to Emmet's opera tion on the cervix, or for the purpose of rendering possible the coaptation of borders of fistuhe The traction may be slight and long continued; thus from to 2 pounds weight exerted for one hour or continuously for eight to ten hours, will suffice to overcome quite firm cicatrices, and to render them capable of being stretched.
Instruments of various kinds may be used (Fig. 68). An elastic band is fixed on them, which may be secured to the patient's body, or to an apparatus with a cross-bar. A small dynamometer may be utilized for estimating the traction force employed.
It goes without saying that these procedures Should be under anti septic precautions, and that wounds caused by the hooks should receive the requisite treatment.