C JE S 



a.iJ thence kfs likJy to injure the women, than tiie more 

 rud; ones coutiivvd by tlic ancients. 



Tlic cirlicA accDUiit w'c find of the cu;rarcan fcclinn in 

 any medical work, is in the Oiiairgia Giiidoiiis dc Caiiliaci, 

 pubiilhed abuiit the iniddle of the fourteenth century ; but 

 the anlhur only fptaki of it as rcfurted to a:t>;r the deatii 

 of the woman, as was pradH'id, he fays, on the bitlh of 

 Julius Ca:far. '• Si auteni contiiigeret nmlitrcm ipfam efle 

 niortiiam ; et fiifpicavcrii quod fietni (.(T. t vivus ; quia vctat 

 lex i-e^'ia iniilierem pregnautem humari, quoufqne iatus 

 »ixerit i tenendo mulieris os, tt malricain aptitani, ut vo- 

 lunt ina!':ms, aperiatur mulicr fccundam lonpitndincm, cum 

 raforio, in latere fmillro ; q'aia pars ilia ell magis libera 

 quani dextra propter hcpar ; ct dijfilis intcrpolitis extra- 

 liant fietuni. Ita enim extractns fun Julius C:j:far ; ut in 

 jrcllis Itgitur Rornanoium." vide Cap. de extractionc foetus. 

 Vigo, who was born towards the ci;d of the Ijth century, 

 in the fli;>rt chapter he gives on difficnlt birtli, takes no no- 

 tice of this mode of delivery ; and Pare, who greally im- 

 proved the praftict of midivifery, thinks the operation 

 only a'lowable on woTnen who die inidchvcred. He had 

 heard, he fays, not without aftoniiliment, of women who 

 had been more tlum once fubjeded to the czfareaii lodion, 

 it not being prafticable to deliver them by any other means; 

 but he confidered the operation as mnch too dangerous to be 

 adopted, " c-jEterum non pofTuni fatis mirari eos qui fibi vifas 

 mulieres affirmant, quibus non femcl novacula abd'^men 

 cnm fubjcdo utiro rclcinum fit ad foctnni, nnnqnam alioqui 

 proditurnm, extrahendcm. Id enim, falva maue, fieri poife 

 mihi perfuaderc-nuiiquam potni," S:c. " De Homiiiis Gene- 

 ratione," cap. 31. l»iit RoufTct, who was contemporary 

 with Pare, having coUetied accounts of a number ot cafes 

 in which the operation was faid to liave been fucccfsful'y 

 performed, publiftied in 1,581, 8vo. " Traite nonveau de 

 i'Hyfterotomotokie, ou Eiifantement cefarien, qui elf I'ex- 

 traflion dc I'enfant par inci-Hon laterale du ventre ct de la 

 matrice de la femme grolfe, ne ponvent autrement accou- 

 cher ; et ce fans prejudicier a la vie de Pun ct de I'autrt, 

 iii cmpecher la fecondae naturclle par aprts." But though 

 Rouflet fpeaks with gre^it co;ifidence of the fafcty of tiie 

 operation, and is v arm in its recommendation, it dots not 

 appeal- that he had ever feen it ptrfornnd, or t!;at more 

 than one of the fix perfons, v\liofe cafes are related by him, 

 were known to him. The book, however, foon became 

 popular, and being lome years aft-.r, viz. 111 1601, tiauf- 

 lated i'.no l^atin by Cafpar Bauhine, witii additional cafes 

 and obfervations, it was quickly circulaltd over Europe. 

 From that time, the operation began to acqu re a certain 

 degree of vogut-, and to be rtfortcd to in cales of extreme 

 difficulty, particularly on the continent, w here it is faid to 

 liave been not unfrequently performed with complete fucccfs. 

 Not fo in this coimtry. In five cafes in which it has been 

 performed at Edinburgh, three of the children were ex- 

 tracted through tiie aperture alive, but the women all died. 

 In England, where the operation has been performed ten 

 times, one of the women only recovered. Tiiis gives little 

 encouiagement for repeating the trials here. But as this 

 almoll uniform faialicy may be in part attributed to the 

 extremely debilitated Hate of the women, who had been in 

 labour feveral days before the operati.jn was determined on, 

 it has been obferved, and with apparent reafon, that if it 

 had beeiv performed earlier, before the llrength ot the wo- 

 men had been exhaulled, and a fcveriih indifpolition induced, 

 or before tne bladder and other foft pans had been injured 

 by dillenfion and prcfTure, a more favourable termination 

 might have been expeded ; as to that cireumftance, viz. 

 a more fpeedy, or prompt determination, may be attributed 



CMS 



the fnper'or fnccefs with which the operation has been 

 ptiforned on the continent. 



Having given this fketch of the hiflory of the Ca;fartan 

 fedion, it remair'S to (late the canfcs renderiig it nrcclLiry, 

 a:;d to defcribe the manner of peiformifg the (.peration. 



Whenever any infurmouniable impediment ex ids, ren- 

 der'ng it impradicable to biiii'.; the cliild through the na- 

 tural paffagc, recoup fc mull be liad to the ca farean fedion,. 

 or the woman, and child, mud inevitably perifli. 



The mod common impediment is, luch a deformed and 

 altered (hape of the bones conltituting the pelvis, as to 

 leave too Imall a fpace for admitting the fingers of the ac- 

 coucheur to pafs between them ; difabling him from intro- 

 ducing and dirvding the ncceffary indrumtnts for opening" 

 and Icffening the head, or other part of the child tiial may 

 happen to prcfent, or lie over the orifice of the uterus. 



Abroad, particularly in France, the cacfarean feftion has 

 been performed where no fiich imptrliment exided, or, at 

 the lead, not to the degree that would be required in this 

 country; as is evident, by the accounts publiflied of wo- 

 men, who after being fubjeded to the operation, have borne 

 living children by the natural palfage, which could not hap- 

 pen, if the pelvis was confiderably didortcd, or mifltapcn. 



Cafes requiring the csefarean fedion, are very rare in this 

 country ; that is, there are very few women wlmfe pelves 

 are fo didorted as not to allow a paiFaije for the fingers of 

 the accoucheur to condud the recedary indruments for 

 opening the head of the fcEtus fufficiently to allow its con- 

 tents to be iqneezed out, and its bones to coll.ipfe fo far 

 as to allow the operator to fix a hook or crotchet, witti 

 which it may tie gradually diawn down, and extrafttd. 

 Through how very narrow a fpace this may be done, we 

 have a remarkable indance related in Dr. Ofborne's " Trea- 

 tife on Laborious Parturition." 



Authors mention other caufes of impediment to the b'rth 

 of the child, as coalefcence of the os uteri, or of the fides 

 of the vagira ; or large tumours filling up that paffage ; but 

 thefe may be all removed by operations much eafier and 

 Icfs hazardous than the carfarean fedion. 



Whenever on repeated examination of a woman in labour, 

 the accoucheur finds the pelvis didorted to the degree def- 

 cribed above, he fliould apprife the hufband of the danger- 

 ous date of the woman, and defire the afiidance of one or 

 two of the mod experienced perfons in tiie prnfrflion, and 

 if on a confuUation it diould appear that it is impcffible to 

 bring the child by the natural paffage, the hufbind (hould 

 be made acquainted with the nature of the impediment, and 

 informed there remains no hope of prele'ving the life of the 

 woman and child, but by opening tlie abdomen of the wo- 

 man, and extrading the child through the wound. At the 

 fame time acquainting him, that the operation, though ha- 

 zardou";, is not neceffarily fatal, many women who fubmit- 

 ted to it having recovered. That the hope o"" a favourable 

 termination depends on its being performed early, before 

 fever comes on, or any material injury ij done to the uterus 

 or neighbouring parts. 



If the hufband (liould be fatisfied of the neceffity of the 

 operation, the woman (hould then be apprifed of her fitua- 

 tion, in the mod cautious manner, and having obtained 

 lier confent, a glyiler is to be thrown up to evacuate the 

 contents of the bowels, and the bladder emptied through a 

 catheter, and a few drops of the tindurc of opium ^vcn 

 to quirt pain as much as poffible,. prior to the operation, 

 the manner of performing which, is thus defcribeel by Mr. 

 Thompfon, late furgeon to the London Hofpital. "Me- 

 dical Obfervations and Inquiries," vol.4. P- ^J^- 



An 



