CESAREAN OPERATION. 519 



ensure the loss of the child, which, in fact, is never extracted alive, 

 excepting in a few cases, appertaining somewhat to the miraculous, 

 unless the extraction be effected during the first moments that suc- 

 ceed the death of the mother. 



Van Swieten and Baudelocque mention three cases of women, 

 supposed to be dead, on whom the cesarean operation was about to 

 be performed, when they recovered from their lethargic state. Pen 

 relates an instance far more calculated to excite alarm : he com- 

 menced his incision, when the woman gave a shudder, accompanied 

 with grinding of the teeth and a movement of the lips. Rigaudeaux 

 has related another one not less remarkable: he was sent for, two 

 leagues from Douai, to see a woman whose labor had excited great 

 uneasmess; when he arrived she was believed to have been dead for 

 two hours. Instead of opening the abdomen without any examina- 

 tion, he explored the genital organs, found the pelvis well formed, 

 and proceeded to turn and deliver the child by the feet, which was 

 born in a state of apparent death, but which with great exertion was 

 brought to life in about two hours. The limbs of the mother pre- 

 serving their suppleness, he forbid them to bury her until the abdo- 

 men should have turned green; after a few hours this woman reco- 

 vered so completely from her insensibility, that she came herself, four 

 years afterwards, to inform Rigaudeaux that she was not dead ! 



Thus, when called to a woman who has lately expired, the first 

 thing to be done is to ascertain the state of the pelvic passages, and 

 whenever they are sufficiently capacious, an attempt should be made 

 to extract the child through the natural passages. In the second 

 place, if hysterotomy is found to be indispensable, it is to be per- 

 formed according to the same rules, and with as great care as if the 

 Avoman were living. By acting in this manner, whatever may chance 

 to occur, we have nothing to reproach ourselves with, and nobody is 

 liable to be blamed. 



1145. When the cesarean operation used to be performed only 

 upon the dead subject, the incision was made upon the left side of 

 the abdomen; "Zef the woman be opened with a razor along the left 

 side,'''' says Guy de Chauliac, '■'■inasmuch as that part is freer on 

 account of the liver.'''' But since it has been attempted upon the 

 living female, it has been subjected to rules formed on a better foun- 

 dation. Among the various methods proposed by different accou- 

 cheurs, there are five which have attracted special attention: in one 

 the incision is made upon the median line, and parallel to the axis 

 of the body; in the second, the cut is made outside of the rectus 

 muscle; in the third, the abdominal parietes are divided transversely, 

 upon one of the sides; in the fourth, the wound is made immediately 



