GASTItO- HYSTEROTOMY 219 



limited powers of regeneration of the elastic fibrous tissue, are 

 important factors. 



The cut through the skin is made from above and behind 

 to before and below, in the direction of an imaginary linj 

 drawn from the external angle of the ilium to right fore claw. 

 Some (Albert) make a perpendicular incision through the right 

 lower flank. The length of the incision is about 40 cm. The 

 abdominal wall is split in the same way as in laparotomy (see 

 page 215). Now the most important part of the operation — 

 metrotomy — begins. 



First the hand acquaints itself in the abdominal cavity 

 with the position of the calf. As a rule, its hindquarters lie 

 close to the wound, it being the most favorable position for 

 extraction. That part of the gravid horn turned toward the 

 diaphragm is drawn with the hind extremity of the calf into 

 the wound, or if possible outside the belly, upon an aseptic 

 cloth resting against the edge of the wound. This manipula- 

 tion is difficult, but it is much better to proceed in this way 

 than to incise the uterus in case it remains in situ. 



The horn, which has been pulled outside the wound, 

 presses upon the edges of the wound, so that any hemorrhage 

 is immediately stopped and the complete occlusion prevents 

 entrance of air and eventration. 



Metrotomy is performed outside the abdominal cavity to 

 stop the foetal waters or uterine secretions from running into 

 the peritoneal sac. The uterus is incised in the long direction 

 of the gravid cornu. The dimension of the cut cannot be given 

 with certainty, since it depends on the size of the foetus. It 

 must be sufficiently large to allow the calf to pass without 

 tearing the edges of the wound. 



As a rule, the incision extends beyond the mucosa into the 

 chorion ; as a result of this the allantoic fluid is discharged. 

 The chorion is now torn by hand and the calf quickly extracted. 



The edges of the uterine wound must be fixed by assist- 

 ants in order to prevent retraction of the incised womb by the 

 uterine contractions and soiling of the peritoneum. Of course 

 it is understood that the assistants have clean hands and 



