520 CESAREAN OPERATION. 



above the Fallopian ligament and parallel to that fibrous band; and 

 lastly, the fifth is made at the level of the crista of the ilium. 



1146. Mauriceaii's method. Solayres, Henkel, Deleurye, &c., 

 are wrong in attributing the idea of cutting down upon the median 

 line to Plainer, to Guerin, or to Varoquier. Mauriceau had ex- 

 pressed himself in the following terms: " Most persons direct the 

 incision to be made on the left side of the belly, but the opening 

 will be better in the middle, between the recti muscles, for in that 

 part there is nothing but the integuments and muscles to be cut." 

 This proceeding, which is preferred by Baudelocque, and now gene- 

 rally followed in France, England, and Germany, permits us to avoid 

 the muscles, and to act only upon the linea alba; only a slight de- 

 gree of gain is produced; no artery can be wounded, and moreover, 

 the uterus is incised parallel to its principal fibres. But it has also 

 been said that this method exposes us to the hazard of inflicting a 

 wound upon the bladder, and that the discharge of the fluids, whether 

 during or after the operation, cannot be effected without difficulty; 

 the wound occupying none but fibrous tissues, is slow in healing, and 

 the uterus being laid open throughout almost the whole extent of its 

 anterior wall, instead of tending to approximate the lips of the divi- 

 sion, rather separates them by its contraction. 



1147. Method of the ancients. In operating upon the side of 

 the abdomen, the ancient accoucheurs generally chose the left side, 

 and made sometimes a straight, sometimes a slightly oblique incision, 

 or one of a crescent shape, but always immediately outside of the 

 rectus muscle. According to the statements of the physicians who 

 employed it, this method has over the preceding one the advantage 

 of avoiding all danger of wounding the bladder, of permitting the 

 cicatrisation to be easily effected, and of rendering the issue of mat- 

 ters that must escape from the wound far more easy. As the womb 

 almost always undergoes a twist upon its axis, inclining to the right 

 or left, it has been supposed that by making the incision along the 

 median line, it would fall nearer to its left edge than to the middle of 

 its anterior region; this also is one of the considerations from which 

 it has been recommended that the operation should be performed 

 upon the side towards which the uterus has naturally deviated. 

 Even admitting all these advantages to be real, they would, neverthe- 

 less, be compensated, it seems to me, by the risk of wounding the 

 epigastric artery or some of its branches; of having a wound, the 

 lips of which it would be almost impossible to keep in contact, on 

 account of the retraction of the oblique and transversalis muscles, 

 and by the impossibility of obviating the absence of parallelism in 

 the two wounds of the abdomen and womb. 



