The patient is placed in the lithotomy position and an Auvard’s speculum is inserted. A piece of stout silver wire or a tenaculum is passed deeply through the anterior and posterior lips of the cervix; steady traction can be made through these and the uterus kept fixed while denudation and suturing are carried out. Should marked extroversion be present, with hypertrophy of the cervical glands, the curette should be freely applied to the diseased surface. The uterine sound is passed to mark the situation of the internal os uteri, and an antero-posterior linear piece of lining membrane, about a quarter of an inch in breadth, must be allowed to remain untouched. This is necessary to prevent total occlusion of the cervical canal when the denuded flaps are sutured (Fig. 65). _Denudation._ The right half of the anterior and posterior lips of the cervix (upper and lower from the operator’s point of view) are first pared by means of the angular knives and scissors, great care being taken to see that the deep angle of the reflexion is not overlooked. The other side is then treated in a similar manner. The tissues will be found extremely hard and resistant, especially if there be much cicatrization about the angle of the laceration. _The passage of the sutures_ (Fig. 65). The short stout, triangular-pointed needle is first doubly threaded with silk or stout chromicized catgut so that a loop of three to four inches in length is produced. The needle and the silk suture are passed as in Fig. 65, two on either side. [Illustration: FIG. 65. TRACHELORRHAPHY. The patient is in the lithotomy position. The left half of the cervix has been denuded and two sutures, _a_, _a'_ and _b_, _b'_, passed. The right half is intact, but the method of passing the needle _n_ is indicated. _ant._ Anterior lip of cervix. _post._ Posterior lip of cervix. _t,t._ Tenacula. _o.u.i._ Os uteri internum. _sp._ Speculum. _w._ Wire. ] The triangular-pointed needle must be held in Schauta’s specially strong holder (Fig. 73), and should be made to pierce the cervix near the raw surface on one lip, and pushed through the tissues immediately below this to emerge on the strip of unpared cervix already mentioned. It is then carried across the sulcus and is made to emerge through the opposite lip of the cervix. A stout wire is now hooked into the loop and pulled through the needle track. When the two wire sutures are inserted on either side, the flaps are brought together and the wires twisted together. =Results.= Primary union is the rule, and the wire sutures may be removed at the end of the tenth or twelfth day. The cervix has the appearance observed in the nullipara, and may lead to complications in any ensuing labour from difficulty of dilatation. Dührssen modifies Emmett’s operation by a flap-splitting procedure which, however, does not appear to possess sufficient advantages to warrant its general introduction. VAGINAL FIXATION (Hysteropexy)