Diseases of the ovaries : their diagnosis and treatment . posteriorsurface of the rectus muscle, is enclosed in a similar but lessprominent fold. The fold from the umbilicus forming thesuspensory ligament of the liver has been already alluded is witli the later steps of the operation of ovariotomy thatthe peritoneum and its reflections have the most importantrelations. In connection with the first incision it is onlynecessary to add that it must be useless to carry this incisionnearer to the symphysis pubis than the reflection of the peri-toneum from the anterior abdominal wall to the bl
Diseases of the ovaries : their diagnosis and treatment . posteriorsurface of the rectus muscle, is enclosed in a similar but lessprominent fold. The fold from the umbilicus forming thesuspensory ligament of the liver has been already alluded is witli the later steps of the operation of ovariotomy thatthe peritoneum and its reflections have the most importantrelations. In connection with the first incision it is onlynecessary to add that it must be useless to carry this incisionnearer to the symphysis pubis than the reflection of the peri-toneum from the anterior abdominal wall to the bladder; andit is a safe rule to stop short of this point, and not carry thelowest point of the incision nearer than two inches to thesymphysis pubis. As a rule, the abdomen is tense, and the incision is madewith an ordinary scalpel held in the first position, as shown inthis drawing. If the operation is performed soon after tapping,and the abdominal walls are very lax, it is convenient to markthe exact line and extent of the incision intended to be made. with ink or chalk, and then, holding up a fold of integument,to transfix with rather a long bistoury, and complete the inci-sion of the skin with one stroke of the knife. The linea albaand any fat behind the recti muscles may then be carefullydivided in the usual way, until the peritoneum is reached. OPENING THE PERITONEUM. 3ol If there is any fluid free in the peritoneal cavity, the peri-toneum bulges into the gap made by the incision, lookingvery like a dark thin-walled cyst, and it has often been mis-taken for a cyst; extensive separation has been made of sup-posed adhesions, while the operator was really stripping theperitoneum from the abdominal wall. When the peritoneumbulges as just described, it should always be opened and thefluid allowed to escape, which the waterproof apron allows to bedone without wetting the patient or its running over the floor,if the sheet is so held as to direct the fluid into the foot-panunder t
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Keywords: ., bookcentury1800, bookdecade1870, booksubjectgynecology, bookyear1
