=Gradual dilatation= by tents. There are three varieties of tents--sponge, laminaria, and tupelo. Sponge tents should never be used, for they are extremely difficult to render sterile. The commonest and the safest to use, because they can be most easily sterilized, are laminaria tents, made from sea-tangle (_Laminaria digitata_). These are cylindrical rods, which expand evenly, from imbibition of moisture. Tupelo tents are larger than laminaria and expand more rapidly. To use tents that are not absolutely sterile is to court disaster, and in former times they were responsible for many fatalities from sepsis. The best way to keep laminaria and tupelo tents is in a solution of 1 in 1,000 corrosive sublimate in absolute alcohol. They may be kept in this for an indefinite period, and so are always ready for use. =Contra-indications.= All septic states of the uterus and cervix, for the retention of pent-up discharges is very likely to lead to local or general infection. Tents should never be used then in such conditions as carcinoma of the body of the uterus, sloughing polypus, acute endometritis and cervicitis. =Method of introduction of a tent.= The patient is placed in the lateral or lithotomy position and a vaginal douche given. A Sims’s speculum is passed and the cervix seized and drawn down with a volsella so as to straighten the cervical canal. The direction and length of the uterine cavity is ascertained by passing the sound. The most suitable size of tent is now selected, and, being held in a special form of tent introducer or suitable pair of forceps, is passed into the cervical canal, well past the internal os uteri. The end should project slightly into the vagina. The vagina should then be douched again and lightly packed with sterilized gauze. The patient must remain in bed. The tent should be left in position for twelve to fifteen hours, when it will have exerted its full action. The action of tents is twofold: it causes (1) dilatation, and (2) softening of the cervix, the softening being accompanied by an abundant secretion of mucus from the cervical glands. =Method of removal.= Tents are removed by traction on the silk thread attached to the vaginal end. The part of the cervical canal which exerts the greatest resistance to the dilating action is the internal os uteri, and after the tent has been removed a well-marked constriction is always to be seen at this point. If there is much resistance to removal by reason of the tent being gripped at the internal os, it should be taken in a pair of forceps and gently pulled and levered out. OPERATIONS FOR HYPERTROPHY OF THE CERVIX This is a congenital condition and there is no thickening of the mucous membrane and underlying tissues; hence the diameter of the cervix is not increased. The operation best adapted for the treatment of this condition is the wedge-shaped incision, recommended by Marckwald (Fig. 62).