THE PLACE OF THE LOW CERVICAL CESAREAN SECTION

It has long been recognized that the risk of cesarean section rises rapidly the longer the patient has been in labor, and the longer the membranes have been ruptured. The mortality of cesarean section in the ideal case, when the patient is operated on before labor, is negligible. In the patient in labor for a considerable time, the mortality becomes a factor to be reckoned with and in the neglected case it becomes formidable. In the preantiseptic days, in an insuperably obstructed labor, the only alternative was to destroy the living child, and the obstetrician sought methods to deliver the child by operation and yet avoid the opening of the peritoneum. The original extraperitoneal operation, with incision parallel to Poupart's ligament, blunt dissection under the peritoneum to the cervix and vagina and delivery through the flank, was suggested by Joerg in 1809 but done first by Ritgen in 1821. The