Treatise on gynæcology : medical and surgical . thermo-cautery, and as the last thing com-plete the division of the pedicle with it. The ends of the ligatures should not be cut until it is sure thatthere is no more oozing and that the threads are placed; but ifthey are left to the end of. the operation, with the idea of a final CASTRATION FOR FIBROMA. 321 supervision, they may do harm by the traction which is exertedupon them. The second ovary is removed in the same manner. If the small incision which I have recommended is not large enough,it would be better to enlarge it either above or
Treatise on gynæcology : medical and surgical . thermo-cautery, and as the last thing com-plete the division of the pedicle with it. The ends of the ligatures should not be cut until it is sure thatthere is no more oozing and that the threads are placed; but ifthey are left to the end of. the operation, with the idea of a final CASTRATION FOR FIBROMA. 321 supervision, they may do harm by the traction which is exertedupon them. The second ovary is removed in the same manner. If the small incision which I have recommended is not large enough,it would be better to enlarge it either above or below rather than touse much force; but it is dangerous to carry this increase too far, orto divide the insertion of the rectus muscle, as has been advised. Ifthe intestines are much in the way the patient should be put inTrendelenburgs position, which causes them to fall toward the dia-phragm (see pp. 87 and 89). Tamponing the vagina or rectum to bring the ovaries out of thelower pelvis is a procedure which is rarely needed in the removal of. Fig. 165.—Hegars Forceps for Cauterising the Pedicle r>* Castratiox. A, Upper surface: B,under surface vrith ivory plate. abnormal organs, for they are then more often found above thanbelow the superior strait. Evisceration or the temporary extraction of a portion of the intes-tine is at times advantageous, but it is so dangerous that I think itshould be kept as a last resort, for it is difficult to replace the intes-tines into the cavity of the abdomen which becomes sensibly dimin-ished by the operation while they become distended with gas. And,finally, the paralysis which sometimes follows their exposure spite of all precautions which can be taken, end in septicaemiafrom the absorption of intra-mtestinal toxic In any case we should not imprudently bring the tumor out of theabdomen; it becomes congested and swollen and very difficult of re-introduction, which exposes to the risk of thrombosis and embolism; 21
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