VAGINAL HYSTEROTOMY. 



549 



eventration can be performed. Nevertheless, it is not always easy ; on 

 the contrary, it is sometimes most difficult and dangerous. 



Either of the embryotoms used for evisceration of the chest may be 

 employed for the abdomen. 



The edge of the instrument is applied to the wall of the cavity, which 

 is incised by drawing the hand towards the operator. Then the whole 

 of the viscera are torn away, and, if need be, that of the chest also, 

 through the diaphragm. 



This terminates what we have to state with regard to embryotomy ; 

 and it will be remarked that nearly all the operations connected with it 

 require much time, are fatiguing for the operator, and only too often 

 very exhausting and serious for the parent. During the operations, the 

 latter should receive the greatest consideration ; from time to time, an 

 interval ought to be allowed for it to rest or to rally from the exhaustion 

 which is always evident to the attentive obstetrist. It may even be 

 necessary to give it a stimulant in the form of brandy, beer, etc., or 

 nourishing drinks — warm or tepid if convenient. 



The greatest care should be observed in preventing injury to the 

 maternal organs from the cutting instruments employed, or from the 

 ends of divided bones 



CHAPTER III. 



Vaginal Hysterotomy. 



At page 349 we alluded to induration of the cervix uteri as a cause of 

 dystokia, and described more or less fully the indications for overcoming 

 the obstacle ; we also alluded to the manner in which these indications 

 should be carried out. As we are now treating of obstetric operations 

 for the extraction of the foetus, it is necessary that we describe more fully 

 the operation and its consequences, as these are of much importance. 



Vaginal hysterotomy consists in incising the indurated and inextensi- 

 ble neck of the uterus, in such a manner, and to such an extent, that it 

 will allow the foetus to pass through its canal. 



For this purpose, the only instrument necessary is a strong probe- 

 pointed bistoury, a bistoury cache, or one of the finger-scalpels or other 

 embryotoms. When the straining of the animal has propelled the cervix 

 uteri towards the vulva, with partial prolapsus of the vagina, the opera- 

 tion is simple, as the eye can then aid the hand. All that has to be done 

 is to glide the instrument into the os, and make the necessary number of 

 incisions through the tissues composing the cervix : the situation and 

 depth of the incisions depending upon the extent of the induration and 

 the atresia. 



In other cases there is no prolapsus of the vagina, which is quite soft 

 and elastic. Then the left hand may be passed into it, and the index- 

 finger being introduced into the os, draws the cervix towards the vulva ; 

 tlie labia of the latter are separated by an assistant, and the operator 

 passes the blade of the instrument — guiding it by the index-finger of the 

 other hand — into the os, where he gradually and steadily incises the 

 tissues. 



