Ccesarian Section 667 



a different direction of the opening for each layer of the abdomi- 

 nal wall. That through the external oblique muscle would be 

 obliquely downward and backward, while that of the internal 

 oblique would be downward and forward, and the two openings 

 would consequently cross each other like an X. 



The peritoneum may be incised with the scalpel, by placing 

 an index finger against it and then passing the scalpel along the 

 finger until it reaches the membrane, when a very slight thrust 

 will force it through. This should be done carefully in order to 

 avoid wounding the viscera, and as soon as the scalpel has pene- 

 trated the peritoneal cavity, as is indicated by the disappearance 

 of resistance, the instrument should be promptly withdrawn. 

 The incision can then be enlarged by means of a probe-pointed 

 bistoury guided by the finger, or it may be readily torn by the 

 fingers. 



The X-formed incision closes automatically, without sutures 

 in its deeper parts, and prevents any protrusion of the vis- 

 cera. It is more tedious than a direct incision into the peri- 

 toneal cavity, and is not so convenient for the operator. The 

 size of the wound must necessarily depend upon that of the 

 species, and should be no larger than necessary to permit the 

 ready withdrawal of the fetus, enclosed within the uterus. 



If the laparotomj' is performed upon the median line, the in- 

 cision is made direct, and should begin slightly anterior to the 

 pubis, and extend forward a sufficient distance to provide an 

 ample opening for the withdrawal of the gravid uterus. 



Having made the incision into the peritoneal cavity, the 

 operator passes his hand around the gravid uterus, draws it out 

 and lays it carefully upon the sterilized gauze surrounding the 

 wound. An incision is then made into the uterus at the desired 

 point, generally upon the convex surface opposite the attach- 

 ment of the broad ligaments, and in a longitudinal direction. 

 If the incision is made near the broad ligaments, it causes more 

 hemorrhage, because the bloodvessels at this point are more 

 numerous and larger. 



Should the suggestion of Harms be followed and the opera- 

 tion on the cow be undertaken in the standing position, the in- 

 cision in the right flank is made merely large enough to permit 

 the extraction of the calf through it. The uterus is then pressed 

 against the abdominal opening, the organ incised, and the fetus 



