Treatise on gynaecology : medical and surgical . schium; by this means we may penetrateabove the levator ani (Fig. 17). Otto Zuckerkandrs transverse perineotomy, dividing the recto-vaginal partition, has been especially recommended for the removalof uterine cancer (Vol. I., page 378), and Sanger has pointed out thatit may also be useful for the evacuation of pus in the cul-de-sac ofDouglas. The incision is carried from one ischium to the other and ateach end may be slightly prolonged from before backward, and fromwithin outward, giving it the form of a trapezium without a base. Thecul-de-sac m
Treatise on gynaecology : medical and surgical . schium; by this means we may penetrateabove the levator ani (Fig. 17). Otto Zuckerkandrs transverse perineotomy, dividing the recto-vaginal partition, has been especially recommended for the removalof uterine cancer (Vol. I., page 378), and Sanger has pointed out thatit may also be useful for the evacuation of pus in the cul-de-sac ofDouglas. The incision is carried from one ischium to the other and ateach end may be slightly prolonged from before backward, and fromwithin outward, giving it the form of a trapezium without a base. Thecul-de-sac may be deeply incised, and the pus evacuated with less 72 CLII^ICAL AND OPERATIVE GYJST^COLOGY. chance of infection than if done through a rectal opening. But thewound, being funnel-shaped, will not allow of the manipulationsnecessary for the removal of a pyo-sali3inx (Fig. 18). 2. Pelvic or Sacral Method?^—Quite recently several plans forreaching the abscess have been proposed. E. Zuckerkandls and Wolflers para-sacral incision, carried deeply. Fig. 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 mi
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