840 Veterinary Obstetrics 



the pessary is from the standpoint of inducing uterine infection. 

 It exerts a concentrated pressure upon a small area of the organ, 

 which weakens the tissues and renders them more susceptible 

 to infection, while the stalk of the instrument constitutes a high- 

 way from the exterior to the cavity of the organ, along which 

 bacteria may freely pass. It is no longer much used in any 

 country, so far as we can determine, and has never acquired an 

 extensive foothold in American practice. 



From the standpoint of efficiency in preventing the recurrence 

 of the prolapse, the pessary naturally occupies a prominent place, 

 but it seems that the dangers which surround its use tend to 

 completely outweigh this one advantage. 



Sutures in a variety of iorms have been recommended by 

 veterinary obstetrists, and are generally preferred to the pessary. 



The sutures may consist of silk, linen, hemp or other vegetable 

 fiber, or of metal. The metallic sutures may be in the form of 

 wire, or special metal bands may be used. The sutures are usually 

 passed directly through the lips of the vulva, but they may be in- 

 serted through the skin near the point of the hip, thus avoiding 

 the wounding of the vulvar mucosa itself. They must neces- 

 saril3' be strong and deeply inserted, in order to afford that amount 

 of security which the obstetrist desires. The number of sutures 

 to be inserted need not be great. Usually a single suture will 

 suffice, if placed sufficiently deep in the vulva, and in no case 

 need there be more than two deep sutures. 



Veterinary obstetrists are by no means agreed as to the com- 

 parative merits of the sutures placed directly through the vulvar 

 lips and of those passing over the vulva and through the skin of 

 the hips. The former are known as labial sutures, and the latter 

 as hip sutures. Some practitioners claim that the labial suture 

 is painful ; that the tissues, being infiltrated and swollen, may 

 readily yield to expulsive efforts, tear out, and the prolapse recur; 

 and that consequently the hip suture is preferable. The latter 

 is applied by lifting up a piece of skin near the tuberosity of the 

 ischium, passing the suture through this fold, carrying it across 

 the vulva to the opposite side, and passing it through another 

 skin fold at a corresponding point. Four to six of these sutures 

 are advised, in sufficienth^ close proximity to prevent any portion' 

 of the uterus from passing out between them. 



