28o Surgical Diseases and Surgery of the Dog 



opposite the insertion of the broad ligament, over one of the fetuses 

 nearest to the fundus of the organ, avoiding wounding the fetal 

 membranes. Extract the fetus and membranes intact and push 

 along the others to the same opening. The fetuses being removed, 

 a few Lembert or Halsted sutures should be applied to close the 

 incision. Some authorities regard this as not being absolutely ne- 

 cessary as the organ very quickly diminishes in volume, the wound 

 closing by its contraction and quickly cicatrizing. 



In inguinal hernia of the gravid uterus, the operation is per- 

 formed in a similar manner after the hernial sac has been opened. 

 Pregnancy with normal delivery of fetuses may subsequently take 

 place. 



HYSTERECTOMY. 



This operation is indicated in hydrometra, pyometra, purulent 

 metritis, in cases of fetal retention and decomposition where the 

 wall of the uterus is involved, in torsion, and in inguinal hernia 

 where the gravid uterus forms the protrusion and it is not con- 

 sidered advisable to replace it in its proper position. It is also 

 sometimes undertaken in preference to hysterotomy and removal 

 of the fetuses in those cases where dystokia is feared as a result 

 of the animal having mated with a male of superior size. 



The ovaries should always be removed at the same time. 



The operation is performed in the following manner: Open 

 the abdominal cavity and draw out the organ as in hysterotomy. 

 Apply stout silk ligatures immediately anterior to the cervix and on 

 the further side of the ovaries, and to sections of the broad ligament, 

 excise the intervening parts with scissors, and return the stumps 

 to the cavity. In the case of the gravid uterus and in the larger 

 animals ligate the arteries separately as one ligature at the cervix 

 is not sufficient for safety. There is liability of such ligatures slip- 

 ping from the stump with secondary hemorrhage as a result. It is 

 well-known that there is a remarkable persistency in the flow of 

 blood from severed vessels of the abdominal cavity even when only 

 small arteries are divided. Larkes had two such unfavorable re- 

 sults attending the removal of the gravid uterus. In cases of puer- 

 peral septic metritis drainage should always be provided for by 

 inserting a fold of sterile gauze within the cavity and carrying it 



