522 CEASAREAN OPERATION. 



pal dangers of the cesarean operation to the double wound of the 

 peritoneum; and further, regarding wounds of the uterus as almost 

 essentially mortal in their character, M. Baudelocque has proposed 

 a new method, which in both these respects appears to him to be 

 infinitely preferable to all others, and which in fact differs from them 

 very considerably. 



The incision is commenced near the spine of the pubis, and ex- 

 tends, parallel to the Poupart's ligament, beyond the antero-superior 

 spine of the ilium. He selects the left side, on account of the in- 

 clination of the cervix, when the womb is oblique to the right, and 

 the right side where there is a left lateral obliquity. After having 

 divided the abdominal parietes without touching the epigastric 

 artery, he pu&hes away the peritoneum from the iliac fossa quite 

 down into the excavation, and detaches it from the upper part of 

 the vagina which he opens; through this opening, which ought to 

 be sufficiently free, the finger is conducted into the os uteri, which 

 is now to be drawn up towards the wound in the abdomen, while 

 the fundus is at the same time pressed in an opposite direction, so 

 as to make it turn over more readily. When the operator has suc- 

 ceeded in bringing the orifice of the womb opposite to the opening 

 made in the abdominal parietes, the delivery is entrusted to the 

 uterine contractions, or provided it should be absolutely necessary, 

 the orifice might be dilated with the fingers, and the foetus extracted 

 either with the hand or the forceps. 



1151. The idea of this method, which the author denominates 

 elytrotomy, is certainly ingenious; he has performed on the dead 

 subject, both pregnant and not pregnant, a number of experiments, 

 which have confirmed him in the favorable opinion he had previ- 

 ously formed concerning it, and which have sufficed to induce some 

 practitioners to suspend their judgment in relation to its value. 

 Nevertheless, I can scarcely believe that it will be found practicable 

 in a majority of cases, or that the laceration of the vagina in addi- 

 tion to the disturbance necessarily occasioned in the iliac fossa or in 

 the excavation would be less redoubtable than the simple and metho- 

 dical incision of the peritoneum and womb, such as may be per- 

 formed in ordinary hysterotomy. I may further add, that M. Bau- 

 delocque himself has very recently been obliged to have recourse to 

 the ceasarian operation, properly so called, after having tried the 

 operation of elytrotomy in the case of a woman who had long been 

 imder his supervision, and in which he was assisted by M. Hervez 

 de Chegoin. I am aware that one single fact does not warrant us 

 in drawing rigid conclusions; but this, which is the only one we 

 have in regard to the living subject, seems to me to lend great force 



