GASTRO-HYSTEROTOMY, OR THE CESAREAN SECTION. 



559 



respects than one. It is true that Bourgelat, describing how gastro-hys- 

 terotomy ought to be performed in the Mare in order to obtain the living 

 foetus, says that the animal should be carefully thrown, placed on its 

 back, and there secured. " Then a crucial incision is to be made at the 

 middle of the lower part of the abdomen, and it should be about a foot- 

 and-a-half in length — terminating at the pubis. If the large intestine, 

 forced outwards by the struggles of the animal, appears, it should be 

 carried to one side, when the uterus will soon be seen ; then an opening, 

 corresponding to the other, must be made with the greatest circumspec- 

 tion, so as not to wound the foal ; the membranes are to be opened, 

 the * waters ' they contain escape, and the young creature is to be im- 

 mediately removed. The success of the enterprise depends upon the 

 attention paid in order to prevent the death of the Mare j the more 

 time lost, so the more is the foetus weakened ; the less time is there to 

 spare if the Mare is dead, for then it is certain that the foal will not 

 live longer than a few moments." The umbilical cord was to be liga- 

 tured at four or five inches from the body of the foal ^ *' after which it is 

 only a question of providing means for rearing the young animal, until 

 it can attend to itself." 



But Rainard points out that nothing is said as to closing and bandag- 

 ing the incision, or the after-treatment of the mare — thus indicating that 

 preserving the foal only was in view. 



With the Mare or Cow, the operation is sometimes attempted in the 

 standing attitude ; but it is obvious that there must be great inconvenience 

 and danger in this. It is much better, therefore, to place the Mare, Cow, 

 Sheep, or Goat, on the left side — right side uppermost ; either side suffices 

 for the Bitch or Sow. 



If the animal is narcotized and insensible, then it is not necessary to 

 secure the limbs ; but if it is only partially, or not at all unconscious, then 

 means of contention must be adopted, for the safety of the animal as 

 well as the operator. The right hind leg should be firmly fixed back- 

 wards, so as fully to expose the region to be operated upon ; the other 

 three limbs are secured together in the ordinary manner. A small animal 

 can be held by one or two assistants. 



The incision, as has been said, is made in the right flank, rather 

 below and in front of the anterior spinous process of the ilium, so as to 

 avoid wounding the circumflex artery — an accident which might embar- 

 rass the operator ; if this or any other artery is wounded, it must be tied 

 immediately. If there is no great hurry, and the hair is long, this had 

 better be clipped off. The incision should pass downwards and forwards, 

 in the direction of the fibres of the small oblique muscle of the abdomen 

 (no muscle should be cut across) ; it should extend through the skin to 

 the muscles, and even if it passes into these, there is no danger to be 

 apprehended. 



The length of the wound will, of course, depend upon the size of the 

 animal : for the Mare or Cow, it may be from twelve. to fourteen inches. 

 The layers of muscles are to be gently cut through until the peritoneum 

 is reached, and into it a small opening is to be made, but in doing this 

 the greatest care is to be exercised, so as not to wound the viscera. The 

 two first fingers of the left hand are passed through this opening, the 

 back of the hand downwards ; the blade of the probe-pointed bistoury is 

 placed between these fingers, and carried along — cutting through the 

 peritoneum and muscles until the opening is of the same length as that 



