^24 CESAREAN OPERATION. 



compresses both oblong and square, a bandage for the body, small 

 and large sponges, a syringe, canulas of gum-elastic, to be used in 

 case it should be necessary to make any injections, water, both cold 

 and warm, and vinegar; wine and. cologne- water are also necessary. 



If possible, the patient should he laid on the bed that she is to oc- 

 cupy during the first few days after the operation; her position 

 ought to be an easy one. She should be placed on her back, with 

 the legs and thighs very slightly bent, and assistants are charged to 

 watch against any sudden movements which the pain might compel 

 her to execute; two intelligent assistants must apply their hands upon 

 the sides and fundus of the womb, so as to circumscribe it very ex- 

 acdy, in order that no organ may happen to slip betwixt its surface 

 and the abdominal parietes, and so that it may compose with the 

 latter parts but one single mass. For this purpose the naked hands 

 seem to me less suitable than they would be if applied upon pieces 

 of broad flat sponge, as advised by Dr. Hedenus. 



1154. "With the convex bistoury the surgeon makes an incision 

 through the integuments, from near the umbilicus towards the pubis, 

 in length from five to six inches, without its being necessary, or 

 always even possible, to pinch up a large fold of them, as advisedby 

 Levret. The sub-cutaneous layer, the aponeurosis and the muscular 

 fibres, as well as the cellular tissue, provided we do not operate upon 

 the median line, are successively divided in the same manner and 

 to the same extent. This incision ought not to be carried too near 

 to the pubis, on account of the bladder, and because the abdominal 

 parietes are generally very thick in that situation. It would be 

 better to extend it above the umbilicus, taking care to pass to the 

 left of it, so as to avoid the umbilical vein, and more particularly, 

 the anastomosis which may exist between it and the epigastric vein, 

 an anastomosis which has latterly been noticed by M. Mesniere, 

 Clement, and Martin. 



After having opened the peritoneum so as to admit of the intro- 

 duction of the left fore finger, to serve as a conductor for the in- 

 strument, the wound in that membrane is to be enlarged by means 

 of the probe-pointed bistoury, to the same extent as the wound in the 

 skin. 



The womb is now exposed; it is to be incised layer by layer, and 

 slowly, until we reach the surface of the ovum; then, in order to 

 retain for the cervix as much of its length as possible, the assistants 

 are told gently to press the fundus of the uterus downwards and 

 make it turn somewhat in front; we might, indeed, like Dr. Kluge, 

 hook the lower angle of the wound of that organ with the finger, so 

 as to favor such a movement, which by affording a facility for ex- 



