CESAREAN OPERATION. 525 



tending the section very far upwards, permits us to guard the cer- 

 vix. In order to avoid the risk of wounding the vessels of the 

 placenta, it is better to use the probe-pointed bistoury to finish the 

 incision, than to have recourse to the grooved director to guide the 

 bistoury with. Further, I can conceive no objection to letting the 

 point of the finger detach the placenta and membranes to a certain 

 extent. 



This is the moment, and not before the commencement of the 

 operation, that it would be perhaps well to follow the advice of Plan- 

 chon, and rupture the membranes by passing the finger up the 

 vagina, either with the fingers alone, or with the instrument of Sie- 

 bold, as is generally done in Germany; supposing, which appears 

 to me preferable, that the membranes should be pierced from the 

 incision, it will be necessary for the assistants to redouble their care 

 to prevent the parietes of the abdomen from abandoning the womb; 

 in this way the effusion of the waters into the cavity of the perito- 

 neum will be obviated, and the tendency of the viscera to escape 

 outwards will remain ineffectual. 



1155. The extraction of the child ought to take place without 

 delay; when it presents by the head or by the breech it is drawn, 

 away in that position, and to favor its escape, the assistants are told 

 to press gently upon the sides of the womb through the parietes of 

 the abdomen; if it be situated otherwise; the feet must be got hold 

 of, and the extraction performed with the same precautions as in de- 

 livery by the natural passages, special care being taken not to bruise 

 or stretch the lips of the wound in the uterus. 



1156. As soon as the foetus is withdrawn, the practice recom- 

 mended by Planchon might be adopted, viz. by means of a sound, 

 the cord might be repassed through the wound, for the purpose of 

 removing the after-birth through the vagina, but no beneficial effects 

 would be ultimately obtained by it, and the celerity of the operation 

 would be sensibily lessened; after all, the retraction of the womb, 

 which would most generally render this operation impossible, soon 

 forces the placenta to engage in the wound, and thus points out the 

 route we should select in extracting it. In order that it may present 

 less volume and less resistance, one of its edges even may be taken 

 hold of, if possible, rather than pull it away by the cord only. As 

 to the membranes, they must be carefully twisted into a rope as in 

 a natural delivery, to prevent any of them from remaining in the 

 uterus. Should any blood have been lost and formed into clots, they 

 ought to be removed with the hand. It would be well, moreover, 

 to cleanse all the parts by means of an injection of warm water; but 

 I do not think that for the purpose of keeping the os uteri open, it is 



