ceedure  all  pull  on  the  traction  forceps  should  cease  while  the
cervix  on  the  dilator  is  pushed  up  as  far  as  it  will  go.  The  vagina
is  thus  put  on  the  stretch,  preventing  the  cervix  from  jumping  off
of  the  blades  of  the  dilator  as  the  dilatation  progresses.  This
maneuver,  shown  me  many  years  ago  by  Dr.  J.  Riddle  Gofife,  if
adopted  will  save  many  an  accidental  laceration  of  the  cervix  that
frequently  occurs  with  the  use  of  the  Goodell  dilator.   This  instru-


172


STERILITY  AND  CONCEPTION


ment,  although  in  almost  universal  use,  is  most  unsafe,  for  its
complicated  mechanism,  designed  to  give  a  parallel  separation  of
the  dilating  blades,  is  weak,  and  when  the  cervix  is  at  all  resistant
they  separate  more  widely  at  the  external  than  at  the  internal  os,
assuming  the  shape  of  a  wedge.  If  the  cervix  is  held  down  near
the  outlet  during  the  dilatation  and  the  traction  forceps  tears  out,
as  it  quite  often  does,  the  cervix  is  then  forced  off  of  the  dilator
when  the  blades,  under  considerable  tension  by  reason  of  the  ten-


Wathen  Dilator.
Sims  Wylie  Dilator.
Goodell  Dilator.
Fig.  28. — Cervical  Dilators.
sion  screw,  spring  widely  apart,  often  tearing  the  cervix  well  up
into  the  broad  ligament.  I  have  seen  a  number  of  cases  where
this  accident  has  happened  that  were  brought  into  the  hospital  in
extremis  from  hemorrhage.
After  the  dilatation  is  well  started  with  the  Sims  dilator,  a
stronger  instrument,  such  as  the  Wathen,  which  is  much  to  be
preferred  to  the  Goodell,  can  be  then  substituted  with  advantage.
