[Illustration: FIG. 104.--Steps of the operation of trachelorrhaphy for bilateral laceration of the cervix uteri: _A_, bilateral laceration with erosion; _B_, the area to be denuded has been marked out with the knife; _C_, the denudation has been accomplished; _D_, sutures introduced; _E_, completed operation.] After the operation the vagina should be washed out with a 1:2000 solution of bichloride; it should then be dried with sponge or gauze, and a light vaginal pack of sterile gauze should be introduced. The gauze pack should be removed at the end of forty-eight hours, and after this a daily douche, with subsequent drying of the vagina, should be administered. The woman should remain in bed for two weeks. There is always present some subinvolution of the uterus, which is much benefited by rest in the recumbent position. The sutures may be removed at any time after two weeks. To do this the woman should be placed in the lithotomy position. The perineum should be retracted with a Sims speculum, and the anterior vaginal wall should be supported by an elevator in the hand of an assistant. If a perineorrhaphy is necessary, it should be performed at the same time as the trachelorrhaphy. In this case the cervix sutures should not be removed for three or four weeks, in order to avoid pressure upon the perineum by the retracting speculum. If there is present marked subinvolution of the uterus with accompanying endometritis, the cervical canal should be slightly dilated and the body of the uterus should be thoroughly curetted immediately before performing the trachelorrhaphy. If the operation of trachelorrhaphy is performed within a few months after the receipt of the laceration--before sclerotic, cystic, and erosion changes have appeared--there is usually required but little preparatory treatment. When, however, there is a marked and widespread erosion, and the cervix is full of numerous Nabothian cysts, or is hard and sclerotic from inflammatory exudate, it is necessary to devote from two to six weeks to preparation of the cervix for operation. Many failures in the operation of trachelorrhaphy are due to neglect of such preparatory treatment. The hard, cystic cervix may unite but imperfectly after operation, or the symptoms referable to the diseased cervix may remain unrelieved by the operation. We often see women in whom laceration of the cervix has been closed with good union, and yet the sclerotic cystic condition of the cervix, and perhaps subinvolution of the uterus, persist, and symptoms continue as pronounced as before operation. The preliminary or preparatory treatment consists of the administration of vaginal douches, regulation of the bowels by saline purgatives, and local applications to, and puncture of, the cervix uteri. The woman should take, two or three times a day, a vaginal douche of one gallon of hot water (110° F.). The douche should be administered in the recumbent posture.