528 VAGINAL-CESAREAN OPERATION. 



1161. Although generally attended with but little danger, the 

 accoucheur would be blameable who should perform it without a well 

 ascertained necessity; I cannot therefore but condemn in decided 

 terms the temerity of those practitioners who do not hesitate to 

 employ it, simply because the os uteri happens to be somewhat 

 tense, and does not dilate according to their impatient desires; and 

 according to what I said when speaking o{ deviations of the os uteri, 

 I have no doubt that it has often been performed when it might have 

 been easily dispensed with. 



In all cases, if there is an orifice, nothing is easier than to per- 

 form this operation; the speculum, employed by some persons is of 

 no use; a probe-pointed bistoury, wrapped round with a narrow 

 strip of linen to within eight or twelve lines of its point, is passed 

 up upon the index finger; in this way we carry it without difficulty 

 within the os uteri, provided it be not too far distant from the centre 

 of the pelvis; in the contrary case. Pott's curved bistoury should be 

 substituted for the straight one. Strictly speaking, one incision 

 might be deemed sufficient; but as it is important that it should not 

 be too deep, it would be preferable to make several of them, at a 

 small distance from each other. At a first view it would seem that 

 the passage of the head could not take place without enlarging such 

 wounds so as to extend them to the body of the womb, and lacerate 

 the peritoneum; but in fact this does not happen, and they com- 

 monly remain limited to the substance of the os uteri. In operating 

 for a scirrhous or fibrous induration, but a very few ounces of blood 

 are found to flow from the wound. M. Duges is, in my opinion, right 

 in recommending that all the diseased parts should be removed at 

 once, instead of merely incising them. 



1162. When the anterior wall of the uterus is divided without 

 extending the cut down to the os uteri, we are obliged to make use 

 of a straight, or convex, and not a probe-pointed bistoury, to begin the 

 operation with, which is always a more delicate one than the pre- 

 ceding. Too much care cannot be taken to avoid wounding the pre- 

 senting part of the fcEtus while making the incision. But, when 

 the womb has been once penetrated, the forefinger becomes a sure 

 director, and the instrument may enlarge the wound as much as 

 necrpssary, without any danger; let us however observe that there 

 is less hazard in extending the incision backwards than forwards, 

 on account of the bladder, and also, that it is useless to make it very 

 large. After the delivery, the wound contracts very rapidly, and it 

 often happens that not a half day elapses before the os uteri recovers 

 its natural situation. If the blood should flow in too large a quan- 

 tity, it would be easily arrested by injections of oxicrate, and by th© 



