LAPAROTOMY 215 



Preparation. — When the cow is operated standing, she is 

 pushed with the left side against some wall or partition and 

 kept there by four assistants. In front of the right hind leg a 

 long pole is driven obliquely into the ground, so that the lower 

 portion of it is right under the right half of the udder, while 

 the free end is pushed against the cow by an assistant to pre- 

 vent her from stepping sideways and interfering with the 

 operator. 



The hair is shaved from the external angle of the ilium to 

 the last rib, and from the transverse processes of the lumbar 

 vertebrae as far as the region of the stifle. Now this part is 

 brushed with soap and warm water and rinsed with a 2 per 

 cent, solution of carbolic acid. All this is done by an assist- 

 ant, and not the operator. 



The operator in between times washes the hands and 

 cleans them mechanically, especially the finger-nails. It is 

 much better to scrub them for a while with warm water and 

 soap, than to dip them simply into an antiseptic bath. 



The necessary instruments, boiled before the operation, 

 are : one bistoury, a pair of forceps, two artery forceps, a 

 probe-pointed bistoury, a pair of scissors, aseptic silk, needles, 

 an Heister needle and thread to suture the skin. Some towels 

 which have been lying in a 2 per cent, carbolic acid solution 

 must also be on hand. 



With the convex bistoury the operator incises the skin of 

 the right flank in the direction of the fibres of the internal ob- 

 lique muscles to an extent of 15 cm. The length of the wound 

 in the Cesarean operation is 40 cm. The incision begins 

 4 inches from the external angle of the ilium and is made of 

 sufficient length forward and downward with one stroke. The 

 second cut severs the fibres of the external oblique muscles in 

 the direction of the skin wound and crosses the fibres of the 

 last named muscle. Now the internal oblique muscle is cut in 

 the direction of its fibres, remembering that it grows thicker as 

 we go up, and that the hemorrhage may be quite severe when 

 branches of the circumflex iliac artery are cut. Finally, the 

 transverse abdominal muscle and transverse fascia are severed, 



