. The Principles and practice of gynecology : for students and practitioners. OP£:RATtONS. 119 pliUHd l)y a ttiiHor or by other causes and is not readilv found, onemay jtroperly ignore it, cut directly through tlie uj)j)er fascial shealh,separate the tihres of the luusele longitudinally, and then divide thestructures l)eneatli until the cavity is reached. When cutting downupon a tumor, one often reaches the linea alba ^vith the first stroke ofthe scalpel, and the subperitoneal fat \Yith the second. The fat isthen se])arated by the finger and handle of the scal|)el, and the jieri-toneal nienil)
. The Principles and practice of gynecology : for students and practitioners. OP£:RATtONS. 119 pliUHd l)y a ttiiHor or by other causes and is not readilv found, onemay jtroperly ignore it, cut directly through tlie uj)j)er fascial shealh,separate the tihres of the luusele longitudinally, and then divide thestructures l)eneatli until the cavity is reached. When cutting downupon a tumor, one often reaches the linea alba ^vith the first stroke ofthe scalpel, and the subperitoneal fat \Yith the second. The fat isthen se])arated by the finger and handle of the scal|)el, and the jieri-toneal nienil)rane exposed. Bleeding points usually are secured by]>ressure-forceps ; ligatures seldom are required. The peritoneum isthen superficially caught by two small pressure-forceps. The oper-ators left hand retains one, and that of the assistant the other. Theperitoneum is usually so translucent that the viscera just beneath canbe seen as it glides over them ; it is now lifted from the viscera bvthe pressure-forceps, and by a single stroke of the scalpel divided Figure Abdominal incision: lower hand holding knife correctly; upper hand holding knife incorrectly. between them. The grooved director formerly in use is rather ahindrance than a help. In grasping the peritoneum in the two for-ceps for incision, one should be careful not to include a bit of intes-tinal wall. The writer once in this way opened the intestine; im-mediate suture, however, resulted in prompt union, and no permanentharm was done. Sometimes the intestine is adherent to the parietalperitoneum and is very liable to be cut unless the incision is madeslowly and with great care. Sometimes one may avoid cuttingthrough the bladder-wall by recognizing in time its greater vascu-larity and the numerous little bleeding points. If the intestines orbladder are adherent and unrecognizable, this fact will be apparentby the failure of the operator to see the viscera through the trans-lucent peritoneum, or by the fact tha
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