The vagina must be large enough to admit of delivery of the uterus through its lumen. Therefore, in virgins and nulliparæ, the abdominal operation is always to be preferred. In any case, if the vagina be too narrow, additional room may be gained by lateral vaginal section (see [p. 148]) or episiotomy.
The operation does not differ in technique from the removal of the uterus for carcinoma, already described. In some cases it may be preferable to bisect the uterus in the sagittal plane before removing it, after the cervico-vaginal attachments have been separated and the peritoneal pouches opened.
SECTION II
CHAPTER I
GENERAL CONSIDERATIONS APPLICABLE TO
OPERATIONS UPON THE EYE
Operations upon the eye differ so widely from general surgical operations that it is necessary to say something of the preparations for them before passing on to their actual performance. Although not formidable in themselves, they require great accuracy and presence of mind; slight mistakes, such as too small an incision, may cost the patient his sight, which sometimes may be almost more important than life itself.
Most intra-ocular operations are performed without general anæsthesia; it is therefore important that the patient should be given confidence by talking to him during the operation, so that he may follow the instructions of the surgeon during its performance; loss of self-control on the part of the patient, movement of the head, screwing up of the eyes, &c., may lead to disastrous results, however well performed the operation itself may be.
GENERAL PRELIMINARIES TO AN OPERATION
The urine should always be examined, especially in cases of cataract, as not infrequently this disease is associated with diabetes, and it is often advisable to treat the general condition before operation.