CESAREAN OPERATION. 517 



and particurarly the one recently made public by Doctor Frank? 

 The wound, which is at first very large, is soon reduced to one-fifth 

 or one-sixth of its original size, and when the organ is free to con- 

 tract, the hemorrhage ceases too quickly for any alarm to be felt in 

 relation to it. Lastly, is it not possible by proper precautions to 

 prevent the liquor of the amnios, the blood and other fluids from 

 being poured out into the peritoneum during and immediately after 

 the operation? 



1140. It would seem then that it is not so much upon itself, as 

 upon the peculiar state of the woman at the time, that the serious 

 nature of the cesarian operation depends. Consequently, I can 

 scarcely refuse to admit the idea, that if we were to act as soon as 

 the indication becomes positive, without waiting until the person be- 

 comes exhausted with vain efforts, the uterus in a state of inertia or 

 on the point of becoming inflamed, if not already so; until peritonitis 

 or enteritis has become imminent, or existent; or lastly, until the pa- 

 tient's life is in danger — the cesarean operation would not be near so 

 often fatal, as, unfortunately, it has hitherto been found to be. 



In support of this view of the subject, I hope I may be permitted 

 to allege a sentiment of Dr. Hull, who attributes the unfortunate 

 results obtained by his countrymen to the circumstance that they 

 never operate, in England, except in desperate cases, whereas upon 

 the continent they are willing to have recourse to it at an early 

 period. 



1141. When the smallest diameter of the pelvis is less than fifteen 

 lines, be the foetus dead or alive, the operation of hysterotomy is the 

 only chance of safety that we can propose to the woman. When 

 this diameter amounts to from eighteen lines to two inches and a 

 quarter, it is equally indispensable, where we do not wish to act 

 upon the child; but in this case, the child must be alive, and further, 

 it remains for us to decide whether it is belter to follow the English 

 doctrine and destroy the foetus, than to expose the mother to the 

 danger of losing her life. Lastly, it may happen that we shall be 

 compelled to resort to it, even although there should be two inches 

 and a half or two inches and three-quarters at the smallest passage, 

 provided the forceps, turning, or the section of the pubes shall have 

 been deemed useless, or have been tried in vain. 



1142. Not only ought the cesarean operation to be performed 

 upon the living subject, but it is also a rule of practice to subject those 

 to it who perish after the seventh month of pregnancy without being 

 delivered. 



The child does not always cease to live at the same moment with 

 its mother, although most frequently it dies first. We might even 

 45 



