220 BOVINE OBSTETKICS 



towels and have been previously instructed. The secundines 

 are detached from the placentas maternse and removed. The 

 uterus, which has contracted still more during this time, is 

 wiped clean with a towel, thus removing the uterine milk and 

 remains of the foetal waters. All this and the suturing is done 

 external to the abdominal cavity. 



Uterine Suture. — Tliis must be made with the greatest care 

 to prevent the uterine secretion from passing through the 

 wound into the abdominal cavity. 



The contraction of the uterus favors the closing of the 

 wound, reducing it about one-half in a few hours after the 

 operation. Cat gut is used as suture, practicing Lembert's 

 method. In order to strengthen the suture, the wound is first 

 thoroughly stitched, bringing the edges into close opposition. 

 Then Lembert's suture through serosa and muscularis is put 

 in, inverting at the same time the first stitches. In this manner 

 firm union is assured. Now the sutures are dried and the 

 uterus replaced. 



The abdominal wound is closed in the same manner as in 

 laparotomy. '^ 



After-treatment. — When a Csesarean section is artfully per- 

 formed, no further treatment is necessary ; only certain com- 

 plications are to be avoided. For the first few days the food 

 must not be voluminous. 



The upper portion of the wound usually heals more kindly 

 than the lower one. Occasionally necrotic tissue is found in 

 the wound after five to six days. It is to be removed and the 

 wound treated on general surgical principles. 



Course of Operation. — Should healing by first intention 

 take place, union of the uterine wound occurs in eight to ten 

 days. The portion projecting into the lumen of the uterus 

 undergoes fatty degeneration ; later it disappears entirely. 

 The localized peritonitis about the uterine wound assists in 

 the union of the serous membranes and does not lead to 

 adhesions. 



The involution of the uterus takes place rapidly, the 

 uterus obtaining its normal form in due time. No rise of tem- 



