Treatise on gynaecology : medical and surgical . 17.—Vertical Perineotomy (Hegar, Saenger). a, Anus; Ti, tuber ischii; mgf, gluteus maximus ;mra, levator ani; Fir, ischio-rectal fossa. along the side of the sacrum, penetrates into the superior pelvi-rectalspace, above the levator ani. Temporary or permanent resection ofthe coccyx and sacrum is a method adopted by Kraske, and modifiedby Hegar (Vol. I., page 380). This operation is of use only when weneed a large field, as in the removal of a tumor; it is not needed forthe purpose of evacuation. These various processes all show ingenuity, and ma
Treatise on gynaecology : medical and surgical . 17.—Vertical Perineotomy (Hegar, Saenger). a, Anus; Ti, tuber ischii; mgf, gluteus maximus ;mra, levator ani; Fir, ischio-rectal fossa. along the side of the sacrum, penetrates into the superior pelvi-rectalspace, above the levator ani. Temporary or permanent resection ofthe coccyx and sacrum is a method adopted by Kraske, and modifiedby Hegar (Vol. I., page 380). This operation is of use only when weneed a large field, as in the removal of a tumor; it is not needed forthe purpose of evacuation. These various processes all show ingenuity, and may be of realservice in special cases, but they are inferior to laparatomy, in that PEEIMETEO-SALPINGITIS. 73 the latter alone j)ermits of an incision large enough and so situatedas to enable us to ascertain where there is a removable x)yo-salpinx ora pelvic abscess, which only an incision can relieve. By adopting theformer means, there is always the risk of simply cutting into sacswhich might be more rapidly and completely cured by Tig. 18.—Transverse Perineotomy (O. Zuckerkandl). A, Anus; R, rectum ; V, vagina ; Mra, levator ani muscle.; Fir, ischio-rectal fossa. 3. 8%il-)peritoneal laparatomy ^^ possesses the decided advantageof avoiding the dangers consequent upon an eflCusion of pus into theserous cavity; it is, for this reason, more advantageous than lapara-tomy properly so called, or transperitoneal laparatomy. But it hasthis drawback, that if the sac is enucleable, even though adherent, itcannot be removed, but merely incised. I am less in favor of thisoperation since our knowledge of pyo-salpinx has become more 74 CLINICAL AND OPERATIVE GYNECOLOGY. definite; yet as it may in some cases be very useful, I will give a raiDiddescription of it. We must, in the first place, by touch and bimanual palpation, as-certain the exact situation of the abscess. Then about half an inchabove the crural arch we make an incision of four to five inches inlength, cutting throu
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