CESAREAN OPERATION. 521 



1148. Method of Lauverjat. To avoid the disadvantages con- 

 nected with these two methods, Lauverjat, who had at first admitted 

 the great superiority of hysterotomy at the median line, attempted 

 to methodise a procedure which had already been resorted to by 

 some practitioners, and recommended a transverse incision about 

 five inches in length, between the rectus muscle and the spinal co- 

 lumn, somewhat below the level of the third false rib, and more or 

 less so, according as the fundus of the womb is more or less remote 

 from it. By proceeding in this manner the fibres of the transverse 

 muscle are rather parted than divided; the epigastric and lumbar 

 arteries are avoided; we fall upon the fundus of the womb, whose 

 cavity forms a sort of funnel, which renders the discharge of the 

 lochia very easy, both by the vagina and hypogastrium; the parallel- 

 ism is easily maintained; the suture is not required; mere position 

 suffices to keep the wound in exact apposition; lastly, the external 

 angle of the cut occupying a low situation, extravasations into the 

 abdomen are incomparably less to be dreaded than in the other 

 methods. But it may be objected that the fibres of the external and 

 internal oblique muscles are necessarily divided; that the least ef- 

 fort must force the viscera out; that the womb being divided at its 

 fundus, where its vessels are largest, soon removes to a considerable 

 distance from the external opening, and that its fibres, by contract- 

 ing, must rather hinder than promote the approximation of the edges 

 of the inner incision; so that, notwithstanding the two successful 

 cases of Lauverjat, and the preference apparently given to him by 

 Sabatier and M. Gardien, this method is evident scarcely less dan- 

 gerous than the two former ones. 



1149. Method of M. Ritgen. Dreading above all things the 

 wounding of the peritoneum and of the body of the uterus, Ritgen 

 has of late recommended that the attachment of the broad muscles 

 of the abdomen should be divided above the crista of the ilium; that 

 the peritoneum should be detached as far as the superior strait, and 

 that the neck of the womb should be divided to a sufficient extent 

 to admit of the extraction of the child. In the first place, I cannot 

 perceive how it would be possible to incise the apex of the womb 

 without cutting the serous membrane with which it is enveloped; 

 then, the difficulties inherent in this proceeding, added to the detach- 

 ment, which would be produced in the iliac fossa, do not appear to 

 me to be of a nature to render the operation at all less serious than 

 those which have been mentioned; besides, as far as I know, at least, 

 the operation is as yet only a project, and no one has put it in prac- 

 tice in the living woman. 



1150. Method of M. Baudelocque, Jun. Attributing the princi- 



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