Originally the indications for cesarean section were limited, because delivery by laparotomy without suturing the uterus, although occasionally successful, nearly always resulted in death from hemorrhage. Suturing the uterus to prevent death from hemorrhage was followed so frequently by peritonitis that Jorg,1 in 1806, suggested a method of extraperitoneal cesarean section which was in fact successfully performed by Ritgen,1 in 1821. Rarely repeated cesarean section was successful in preantiseptic days, in cases in which the adhesions were sufficiently extensive to wall off the peritoneal cavity. Porro, in 1876, devised his operation for removing the uterus and suturing the cervix into the laparotomy wound. While the Porro operation greatly reduced the mortality of cesarean section, the removal of the uterus was considered to be too radical a procedure to permit of any marked increase in the list of indications for cesarean section.
But when Sänger, in 1882, described his
SPALDING AB. CESAREAN SECTION SCARSA HISTOLOGIC STUDY OF FOUR SPECIMENS. JAMA. 1917;LXIX(22):1847–1855. doi:10.1001/jama.1917.02590490011002