[Illustration: FIG. 76.--_A._ The sutures have been introduced. The prolapsed vagina and cervix have been reduced. The cystocele is pushed upward by the staff, so that the denuded strips may be brought into apposition. _B._ The sutures are secured. The cystocele has disappeared. The area of the anterior vaginal wall and the caliber of the vagina have been much diminished.] [Illustration: FIG. 77.--_A._ A point on the median line of the posterior vaginal wall, about an inch below the cervix, has been seized by the tenaculum. This marks the apex of a triangle the base of which is at the ostium vaginæ and the sides of which are on the lateral vaginal walls. _B._ The triangle has been denuded. The sutures have been introduced.] Whenever there is hypertrophy of the infra-vaginal cervix, this structure should be amputated in addition to the other operations. [Illustration: FIG. 78.--The sutures in the posterior vaginal wall have been secured. The caliber of the vagina has been very much diminished. A strong sling or band of tissue has been formed immediately above the ostium vaginæ, which supports the lower portion of the posterior vaginal wall. The operation is completed.] In those very rare cases of incurable prolapse that have resisted all conservative treatment the operation for the removal of the uterus may be considered. The writer has never resorted to it. The operation consists in supra-vaginal hysterectomy followed by fixation of the cervical stump by sutures to the abdominal wall. This operation, however, should not be proposed hastily. The surgeon should not become discouraged by one or even two failures of the more conservative methods of treatment. Though the first plastic operation may fail to retain the uterus inside the body, yet something is always accomplished by it, and when supplemented by a second or a third operation, cure will often result. The operative procedures required in a case of prolapse of the vagina and of the infra-vaginal cervix, with hypertrophy of the infra-vaginal cervix and elongation of the supra-vaginal cervix, are illustrated in Figs. 71-78. The condition represented in Fig. 71 is that which is commonly spoken of as “prolapse of the uterus.” It is the usual form of prolapse. It may be cured in the very great majority of cases by the operations which are here depicted. A great number of mechanical devices have been introduced for the relief of prolapse of the uterus. Every vaginal pessary has been used for this condition. None of these implements cure the disease. All of them, if used continuously, produce ulceration of the vagina and of the cervix from pressure, and must be abandoned until such lesions heal. In those cases of prolapse in which pessaries remain in the vagina and support the uterus, without producing ulceration, operation would effect a cure. [Illustration: FIG. 79.--Braun’s colpeurynter.]