HISTORY OF GYNECOLOGY IX AMERICA li
bladder and its raw surfaces approximated with buried catgut sutures, after which the vaginal walls are sutured together, closing in the entire raw area. ("American Journal of Obstetrics," vol. xxxi, 1895.)
John Ball, in 1873, wrote upon "Forcible and Rapid Dilatation of the Cervix Uteri for the Cure of Dysmenorrhea."
Lacerations of the Cervix. — T. A. Emmet devised and extensively practised the operation of the excision of connective tissue in the angles of a lacerated cervix associated with the denudation of the anterior and posterior lips and their union by suture. ("Surgery of the Cervix," etc.; "American Journal of Obstetrics," vol. i, 1869; also vol. vii, 1874.) This operation of recent years has been largely abandoned for the more radical German method of amputation of the cervix.
In perineal operations, Emmet's name stands pre-eminent as the one American who placed this common operation for the first time upon a sound, rational basis, by devising a successful widely-used procedure. The student of gynecological history has but to recall the painful efforts of his predecessors, Agnew, Ashhurst, Goodell, and others who made a bilateral, semicircular denudation called the "butterfly operation" and then drew the tissues together with deep wire or silk sutures which caused extreme pain commonly associated with suppuration.
Lawson Tait's flap operation, for many years refused by American surgeons preferring Emmet's methods, has latterly found favor associated with suture of the levator ani muscles; its simplest expression is the operation practised by Wayne Babcock, of Philadelphia. ("Journal American Medical Association," May 15, 1909, vol. xlii.)
In complete tear of the perineum, Emmet's work has also been su- preme; to this C. Warren has made the important addition of turning down an apron of tissue from the perineum so as to shut off the rectal side of the tear. ("Transactions of American Gynecological Society," vol. vii, 1882; also "Boston Medical and Surgical Journal," January 3, 1878.)
R. L. Dickinson and J. Le Conte have added the special direct suture of the sphincter muscles, the former in recent obstetric cases, the latter in older cases.
George H. Noble has added the liberation and displacement down- wards of the rectum itself to make up the defect and obviate the need of placing sutures on the bowel side
Cervical Cancer of the Womb. — The evolution of the radical operation for cancer has been profoundly influenced by the work of a notable group of Americans.
In 1895 J. G. Clark, while still a resident in the Johns Hopkins Hos- pital, undertook to co-ordinate the operation for cancer of the cervix of the uterus with that of the breast, as worked out by Halstead, by mak- ing a wide extirpation including all the pelvic glands. ("Johns Hopkins
