The Abdomen 137 



tissue of the linea alba. Union of muscular fiber, particularly by 

 first intention, is always stronger than union by granulating cicatri- 

 cial tissue. Human surgeons recognize, that the commonest factor in 

 the development of hernia is an infection causing the wound to fill 

 in slowly with scar tissue. Median section has a disadvantage in 

 males, in that the wound may become soaked with urine. Even 

 if the incision be made posterior to the preputial orifice, and this 

 difficulty thereby avoided, there still remains a pronounced tendency 

 to the development of suppurative processes. The reason for this 

 is to be attributed to the proximity of the penial mucosa, which is so 

 often the seat of catarrhal discharges, and whence microorganisms 

 can so easily be transmitted to the wound during the course of an 

 operation^ and later by the animal licking the parts. 



In the lateral position the risk of hernia is almost nil, but 

 among the drawbacks are : the greater thickness of muscular tissue 

 which must be divided; the necessity of securing the epigastric 

 vessels ; and the tendency of pus to burrow between skin and wall, 

 and even into the peritoneal cavity in the event of the wound sup- 

 purating during healing. Should purulent peritonitis intervene, 

 either from such burrowing or incident to secondary operations on 

 internal organs, the chances of recovery are remote, in consequence 

 of absence of drainage. 



Generally speaking, the organs are best reached as follows: the 

 stomach, spleen, pancreas, and liver, in the anterior third — i. e., 

 immediately posterior to the thorax; the ovaries and intestines ex- 

 actly in the center of the distance between the ensiform process 

 and the symphysis pubis; the uterus, bladder, ureters, and rectum 

 immediately anterior to the pubis. 



When the operation is undertaken as an explorative measure 

 the surgeon is, figuratively speaking, groping in the dark. In such 

 instances the middle third should be chosen. 



Instances have been recorded where it has been found neces- 

 sary to close the first incision and make a second one before the 

 seat of lesion could be reached. Venneholm described an opera- 

 tion for fecal impaction, the mass of which was lying in front of 

 the pubic bone. The mass was mobile, and the operator expected 

 to reach it without any trouble. The first incision was made in 

 the linea alba, but the obstructed portion of the bowel could not 

 be extracted. It was then necessary to make a second incision to 

 the side of the prepuce. 



