PART III. THE ABDOMEN AND PELVIS. CHAPTER I. THE OPERATION. The cavity of the abdomen, may be opened without disturbing that of the chest. An incision from sternum to pubes, down the central line, and through the superficial structures, should be followed by a careful division of the tendinous portions of the muscles and peritoneum, for a sufficient space to admit two fingers, when, by introducing the same, the remaining portion may be divided without risk of injury to the intestines. A cross incision having been made at the umbilicus, the angular flaps may be turned aside, fully exposing the abdominal contents. Where the chest is opened at the same time, the transverse incision will not be required. The peritoneum, with any serous or other contents having been examined, the attention may be given to any special organ or part that may be involved, or each may be taken up seriatim. In many instances there will be no occasion for removing any of the viscera, while in others, one or all of the organs may require so careful an examination, as to necessitate an entire removal from the body. The _small intestines_ may be removed _en masse_, or in sections. After applying double ligatures at the lower end of the ileum, and just below the duodenum, the bowel may be divided between these, when, by dividing the mesentery near its intestinal border, with either the knife or scissors, the whole mass may be removed. By means of the _enterotome_, they may now be rapidly laid open through their entire length, the contents removed, and the surface cleansed if desired for more careful inspection. Occasionally, portions only of the small intestines will require examination. By applying double ligatures, above and below the portion to be examined, the removal is effected without escape of the contents into the abdominal cavity. In the removal of the _colon_, either in sections, or as a whole, the same care should be observed in the application of the ligatures. The rectum having been divided, it may be lifted and rendered tense, its attachments, with those of the ascending transverse and descending colon, being successively divided with the knife, and thus the whole gut removed and afterwards split open with the enterotome. The removal of the _rectum_, for the examination of its whole length, will usually require the removal of the other pelvic viscera, directions for which will be given further on.