CESAREAN OPERATION. 527 



operation should be removed; she is to be placed in the middle of 

 her bed, taking care to move her as little as possible, and we should 

 endeavor to place her so that her muscles may be all in a state of 

 relaxation. 



1159. Some antispasmodic potions, slightly opiated, to calm the 

 nervous agitation; some precautions to ensure the discharge of the 

 lochia by the vagina instead of their escaping into the peritoneum; 

 diluting drinks, bleeding and leeching as soon as any symptoms of 

 inflammatory action become manifest, and the greatest repose, both 

 of mind and body, are all that the surgeon can recommend to the 

 patient to obviate the dangers which threaten her. 



SECTION 5. 



Vaginal-Cesarean Operation. 



1160. According to the reports of authors there are a great num- 

 ber of causes which may necessitate the performance of the vaginal- 

 cesarean operation: an obliteration, with fibro-cartilaginous indura- 

 tion of the OS uteri, as in the case related by Simson, and also in 

 that other case spoken of by Van Swieten; violent convulsions 

 which endanger the life of the woman while the orifice is too tense, 

 and still insufficiently dilated to admit of the introduction of the hand, 

 as is observed in the cases by Dubosq and Lambron; an extreme 

 obliquity of the orifice backwards, while the head of the child at the 

 same time forces down into the excavation, and even as low as the 

 vulva, the anterior portion of the womb, which it distends, renders 

 thin, and would at last rupture, provided an incision were not soon 

 made, as was done by Lauverjat — such are the occurrences which 

 have most frequently rendered it necessary; it may also become use- 

 ful where the uterus, having escaped from the pelvis during preg- 

 nancy, has never been reduced, and where its orifice cannot be di- 

 lated by means of the fingers, although there may be danger in 

 delaying the delivery, as in the examples cited by M. Thenance, 

 Jacomet, and a surgeon at Vaux mentioned by M. Bodin; but it has 

 been proposed more particularly in cases of scirrhus, and where the 

 orifice presents such a resistance to the contractions of the womb 

 that the woman is exhausted in vain efforts without effecting its dila- 

 tation; lastly, it would be equally well indicated, as M. Bodin has 

 attempted to demonstrate, in cases of arm presentation, should it 

 ever in any case be found really impossible to proceed in search of 

 the feet, and if no other means of avoiding the amputation of the arm 

 could be availed of. 



