Cystic Degeneration of the Ovisacs 405 



place the ovary against the bony wall of the pelvis and then 

 exert pressure against the opposite side with the hand, thus 

 impinging the ovary between the hand and the pelvic bone. 

 The rupture of ovarian cysts per rectum must always be 

 carried out with prudence. The fingernails should be 

 trimmed to the quick and carefully smoothed in order to in- 

 sure the maximum of safety against injury to the rectum. 

 Pressure must not be exerted upon the cyst when the rec- 

 tum is contracting. If, during the compression, the pa- 

 tient begins to strain, the pressure must be relaxed and, if 

 necessary, the ovary released in order to avoid rectal lacera- 

 tion or rupture. 



Unless the cyst can be ruptured safely and readily per 

 rectum, the effort should be promptly abandoned and the 

 operation carried out per vaginam. The ovary should be 

 picked up per rectum and carried backward over the vaginal 

 roof. The operator then inserts his other hand into the 

 vagina and grasps the cystic gland through the vaginal 

 wall, the ovary being pushed down by the hand in the rec- 

 tum into the hand in the vagina. It is then grasped per 

 vaginam, while the hand within the rectum lends security to 

 the grasp by continuing a hold upon the mesometrium at its 

 attachment to the ovary and maintains a pressure down- 

 ward, while the hand in the vagina presses upward. The 

 operator may- also with safety avail himself of the assist- 

 ance of a colleague or a layman in his efforts to rupture the 

 cysts per vaginam. Any intelligent layman can be trusted 

 under proper supervision to exert pressure per vaginam. 

 His nails should be trimmed as noted above, and if his 

 hands are horny from manual labor they should be softened 

 with warm, antiseptic solution. The veterinarian should 

 locate the cystic ovary per rectum, obtain a secure grasp 

 upon it and draw it back over the vagina. The assistant 

 should then insert his hand, well lubricated, into the vagina, 

 with his palm upward. The veterinarian pushes the ovary 

 into his open hand from above and maintains his grasp upon 

 the ovarian attachment. He then pushes downward and 

 steadies the gland while the assistant pushes upward 



