VAGINAL HYSTEROTOMY. 553 



operation, the blade being covered for one-half its length by a bandage. The instrument 

 is carried in the hand, so that the forefinger covers the back of the blade, while the 

 remaining four fingers firmly grasp the handle. The hand — well oiled — is passed 

 into the vagina, and after the external ring of the cervix has been incised — right and 

 left — to the depth of one-third to half an inch, towards the top, attempts are made, by 

 careful manipulation, to further dilate the passage. This procedure has, as a rule, 

 been attended with success. The iimer ring is reached, after this manipulation has 

 been continued for some time ; and this is dilated, partly by incision, and partly by 

 pressure or distention — though care is taken to avoid contact with the incisions already 

 made. This happened, however, in his first case, in which the textures between the rings 

 had to be divided. Sometimes the knife is dispensed with in the course of the operation, 

 and the hand alone is made to trace the channel, which has often a devious course. 

 During the '" pains " the knife is very liable to slip from the hand and injure the uterus 

 — thereby causing unnecessary haemorrhage. In four cases, in which, after the widen- 

 ing of the incisions, birth took place in a normal manner, the result was most satisfactory ; 

 the animals operated upon recovered completely, and after only a brief indisposition. 

 Two afterwards became pregnant, and calved without any difficulty. 



In the other two cases the results were not so favorable : the calves being too large to 

 pass through the vagina, and the Caesarean section was objected to by the owners, and 

 was certainly not deemed very, likely to be attended with success by Foglar. 



After parturition, the foetal membranes were either removed artificially, or left to 

 nature ; and in no instance were any ill consequences noted. In the first case the 

 "afterbirth " came away on the ninth day ; and in all the cases the subsequent treat- 

 ment chiefly consisted, for the first two or three days, of cold applications to the loins, 

 cold water pessaries in the vagina, gruel, and Glauber's salts, with, in particular instances, 

 injection of cold water into the genital canal. 



6. Macgillivray {Veterinary journal, 1S77, p. 149),. referring to the instances alluded 

 to at p. 352, adds : " In the first case the subject was a seven-year-old Cow, on which I 

 operated by incision (making two side cuts up and down), and extracted two living 

 calves. Both calves and the Cow did well. Having made a speedy, good, and perfect 

 recovery, the said Cow was in due course again served with the Bull, and the following 

 season produced (without any uncommon disturbance) a living calf ! Thus showing that 

 incision of indurated cervix uteri is no bar to future productiveness of a perfectly normal 

 character." 



There is no doubt that, in the majority of instances, and in the hands 

 of careful obstetrists, vaginal hysterotomy will be successful, and will 

 prove a useful operation. 



As a rule, after the operation, and for a period of eight or ten days, 

 there is a muco-purulent discharge from the vulva ; but the Cow eats, 

 ruminates, gives the usual quantity of milk, and does not appear to be 

 any more inconvenienced than after normal parturition. 



The unfavorable results, however, must not be overlooked. Serious 

 injury to the neighboring organs by the knife, or by the extension of the 

 laceration, is within the range of possibility. When the cervix is com- 

 pletely divided, either by incision, or by subsequent laceration during the 

 passage of the foetus, we may have intense peritonitis arising from escape 

 of the liquor amnii or other fluids into the abdomen, and speedy death. 

 Or excessive haemorrhage may lead to serious consequences. 



In every case, of course, there must be more or less bleeding from the 

 incisions ; but, as a rule, this is of no importance, and it ceases after a 

 time. In less frequent cases, however, it persists, and either brings 

 on great debility, or, if excessive, will lead to a rapidly fatal termination. 

 This result is most to be apprehended when the cervix is greatly degen- 

 erated, and its tissue extremely vascular — as in carcinoma and sarcoma. 

 It may also occur from rupture of blood-vessels, in laceration of the cer- 

 vix or body of the uterus, during the passage of the calf through the 

 incised os. 



When serious haemorrhage occurs, cloths or sponges steeped in cold 

 water, astringent lotions, and styptics — as the perchloride of iron — 



