RUMENOTOMY 409 



this and other abdominal operations. Except when instan- 

 taneous relief is needed to forestall impending death, rumen- 

 otomy should be performed under the strictest possible anti- 

 sepsis. The field should be shaved, well washed and disin- 

 fected and the environs well moistened to prevent flying of 

 loosened hairs. The instruments, and especially the needles 

 and sutures, must be aseptic. 

 INSTRUMENTS, ETCX 



i. Scalpel, and probe-pointed bistoury. 



2. Dissecting forceps. 



3. Artery forceps. 



4. Spring retractor. 



5. Two strong tenacula or tumor forceps. 



6. Needles, catgut and silk. 



7. Collodion. 



8. Antiseptics. 



TECHNIQUE.— First Step. Abdominal Incision.— The 

 incision through the abdominal wall is made five inches long, 

 midway between the external angle of the ilium and the last 

 rib, beginning about two inches below the transverse process 

 of the lumbar vertebrae. The incision may be vertical or ob- 

 lique, preferably oblique, so that all of the abdominal muscles 

 are not cut transversely. The skin and muscles are incised 

 with the scalpel and the peritoneum with the probe-pointed 

 bistoury after it has been perforated inferiorly with the 

 former. 



Second Step. — Rumenotomy. — The spring retraction is 

 now adjusted to the incision and the rumen incised in the 

 same direction as the abdominal incision, but the length of 

 the incision should be about one inch shorter. In order to 

 prevent the flow of ingesta into the peritoneal cavity from 

 the very beginning, the rumen is first punctured with the 

 scalpel at that part occupying the middle of the abdominal 

 incision. In acute bloat as the contents gush out with 

 great force, the index finger is immediately hooked into the 

 perforation thus made, and the rumen drawn out as far as 

 possible (four inches or more) where it is held until the flow 

 ceases from the gradual diminution of the abdominal tension. 

 It is important not to make this perforation too long, because 

 sudden evacuation may provoke shock that will manifest it- 

 self after the operation'is completed. 



The abdominal tension having now been relieved, the 

 tenacula are hooked into each edge of the perforation and 

 the incision enlarged upward and downward to the pre- 

 scribed length, 



