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OBSTETRIC OPERATIONS. 



When, however, the walls of the vagina are involved in the induration, 

 this retraction of the cervix cannot be effected, and the part must be op- 

 erated upon in its ordinary situation : the knife being carried carefully 

 into the vagina, passed to the necessary depth in the os, and the incision 

 made. Perhaps the bistoury cache is the best instrument for such cases. 



It is rare indeed that one incision is sufficient; generally from two to 

 four are required, and it is better to have a larger number than make 

 them too deep ; they certainly must not pass through the entire thickness 

 of the cervix. 



The situation of the incisions is a matter of some moment. The lower 

 portion of the cervix should be avoided, in consequence of its proximity 

 to the floor of the vagina, which is in immediate contact with the bladder 

 and urethra ; should these be wounded, the results might be serious, if not 

 fatal ; and if the peritoneum is cut or torn during the passage of the 

 foetus, fluids and discharges will escape into the abdominal cavity, and 

 give rise to peritonitis. There is less danger in incising the upper part 

 of the cervix, as the rectum is not so near ; nevertheless, in induration 

 there may be adhesions between them, and an accident is therefore pos- 

 sible — though it must be rare. 



So that, if only two incisions are required, it is advisable to make one 

 on each side of the cervix ; and if four are necessary, to have them at 

 each corner. 



Horsburgh {^Veterinarian, vol. xviii., p. 215) recommends, if the atresia 

 is complete, to pass the finger or a blunt instrument into the os, then in- 

 troduce a stout, sharp-pointed, curved bistoury about four inches long — 

 dividing the stricture laterally by two incisions — always drawing the bis- 

 toury towards the operator ; after which he is to introduce both hands, 

 with the palms towards each other, and press them apart. " He will 

 find the part immediately dilate to the proper size, and labor may go on 

 naturally ; or he may then proceed to extract the calf if labor has been 

 protracted." 



The object in making the incisions only to a comparatively slight depth, 

 and not through the entire thickness of the os, is to prevent extensive 

 lacerations of the organ during the passage of the fcetus. It will gen- 

 erally be found that these partial incisions will, with a little patience, 

 admit the hand ; this being passed into the uterus, seizes the presenting 

 part of the young creature, places it in a favorable position if necessary, 

 and then begins to draw it gently into the os. 



Sometimes with primiparae in good health and strong, delivery is after- 

 wards effected spontaneously, and this is the most favorable result ; but 

 in the majority of cases labor has been going on for a long time — per- 

 haps two days or more, the parent is exhausted, and the uterine contrac- 

 tions are either suspended, or so feeble as to preclude all hope of their 

 expelling the foetus. The head and fore-feet must then be corded, and 

 delivery accomplished in the ordinary way. 



It is well to remember, however, that the traction resorted to must be 

 judiciously employed. It should be moderate, gradual, and sustained, in 

 order to allow the tissues of the cervix time to accommodate themselves 

 to the eccentric pressure imposed on them by the advancing foetus. To 

 act otherwise, is to incur the grave risk of lacerating the uterus beyond 

 the possibility of repair, and is quite as reprehensible as making deep 

 incisions. 



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