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After the ovum has been implanted in the lining of the uterus, this does not merely stretch to make room for the growing child. It also grows, becoming a heavy muscular organ. At the fourth or fifth month it has grown as high as the umbilicus, and at full term reaches to the top of the abdomen. When labor starts, the powerful and decidedly unpleasant contractions demonstrate the presence of plenty of musculature. I said that the uterus grew large but did not stretch. That is so until labor begins and then this versatile muscle adjusts itself most remarkably. While the upper part remains heavy and strong, the lower part does begin to stretch until finally there is an opening large enough to let the baby’s head through. And then when the baby leaves, the great muscle contracts down until, having pushed the placenta or afterbirth out, it is small enough to nestle well down in the pelvis. Truly an ingeniously adaptable musculature.
Shakespeare tells us that Brutus gave Caesar the most un-kindest cut of all; one of my fellow-surgeons way back in those days did just the opposite, for it is said that Caesar was born by way of a cut through his mother’s abdominal wall and into her uterus. Such deliveries have become common now and, until the last quarter century or so, had not changed greatly since the old Roman days. It must have been rare for a woman to survive this operation before the days of anesthesia and asepsis. Even with those aids, one took an added risk in doing a Caesarean. There was considerable blood loss and danger of peritonitis if the woman had been subjected to previous examinations. Today surgeons proudly do an operation which does not open the abdominal cavity at all. I am able to give you a good description of this operation from a source one hundred and twenty-five years old. Dr. William Potts Dewees wrote a famous System of Midwifery and in it was a letter from one Dr. Horner, regarding the Caesarean section.  I quote:
Dr. Physick proposes that in the Caesarean operation a horizontal section be made of the parietes of the abdomen just above the pubes. That the peritoneum be stripped from the upper fundus of the bladder by dissecting through the connecting cellular substance which will bring the operation to that portion of the cervix uteri where the peritoneum goes to the bladder.
As some of these words may be unfamiliar to you, I will elucidate. The operation consists in cutting across the lowest part of the abdominal wall. The lining of the abdominal cavity reaches as low as that. As it is loosely attached to the bladder it may be dissected free and pushed up. Hence without opening the cavity the surgeon may reach the lower part of the uterus. This is cut open, the baby and afterbirth extracted, and all the layers sewn back in place. When Dr. Physick suggested this, there was no anesthesia or asepsis. Patients just could not stand such long careful dissections. About a quarter century later the use of ether for anesthesia was begun, and before the end of the century asepsis was developed. It was a good many years more, however, before this operation so well described by Dr. Physick was adopted. This was presumably due to the modern contempt for historical perspective. The late Dr. Samuel C. Harvey, professor of surgery at Yale, told me that it was a rare student who felt there was anything worth knowing that was over ten years old. Probably some proud surgeon invented this operation a century after Dr. Physick had described it.  It might well have been used many years before.

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