MIDWIFERY. 
and the head cannot pass; the question is 
then changed, what method have we to 
bring the child out of the body, if it cannot 
pass through the pelvis? and here it has 
been proposed to cut it out from the body , 
by the following operation. 
Casarean Section. This has been perform- 
ed in two ways, by an incision obliquely 
carried through the side; or through the li- 
nea alba directly down. The object pro- 
posed in this operation is to save the hte 
both of the mother and child. It is of great 
antiquity. It is said that Julius Csesar was 
taken this way out of the body of his mo- 
ther ; but tliere is no just ground tor re- 
lieving such a report : many historians held 
him as so remarkable a man that they were 
determined he should not come into the 
world like any other person. If it had 
been so, is it not strange that Pliny, who 
wrote so soon afterwards, should devote a 
(iapter entirely to the history of a living 
child being cut out of the body ol the pa- 
rent who was dead, and yet mention no- 
thing of Julius Caesar’s having come the same 
road. Scipio Africanus is said to have been 
introduced by the Caesarean section, but 
there is no reason to believe it. It was ne- 
ver known otherwise than as an operation 
recommended till the sixth century in Pa- 
ris. It was also once performed in Hol- 
land by a sow-gelder upon his wife. It is 
remarkable that the same woman was after- 
wards pregnant; but when her husband 
proposed the operation again, she declined 
gubraitting to it, and was delivered without. 
The surgeon who strongly recommended it 
in Paris, was Rousset, who never lived to 
see it performed, on account of the opposi- 
tion he met with in opinion from Ambrose 
Par6e and other eminent surgeons. 
The manner of performing this operation 
has been much disputed ; the lateral inci- 
sion appears to be the best; because we di- 
vide one muscle and it retracts, we divide 
the muscle under it, and it retracts also ; 
but the whole of the incision will not be a 
direct line through, so that we stand a bet- 
ter chance of saving our patient, as far as 
exclusion of the air may have a good effect, 
when the parts come afterwards to unite. 
Of the two plans of performing the ope- 
ration, the lateral incision then appears to be 
the best; and in making it we must attend 
to the following points : the woman may die 
under the operation itself ; or shortly after, 
from the loss of blood ; from exposure of 
the cavity of the abdomen, causing exten- 
sive peritoneal inflammation ; from the 
parts suppurating, instead of uniting by the 
first intention ; or from inflammation being 
so violent as to prevent the formation of 
matter, producing mortification. Yet if we 
look at the cases of this kind that are re- 
corded, we shall see the fairest accounts 
that could be wi'itten, the death of the pa- 
tient never being attributed to the opera- 
tion, but to some trifling cause, perhaps re- 
lating to diet ; such as a small glass of wine, 
or a few grapes producing inflammation of 
the peritonaeum, or diarrhoea. This is de- 
cided upon without considering the proba- 
bility that the diarrhoea or peritonaeal in- 
flammation may have been produced by 
the operation alone. These things should 
be considered fairly, and not viewed with 
the partial eye of him who has performed 
the operation. We see that on the conti- 
nent this operation has been very rarely 
successful, according to Bourdelet, not in 
one case out of ten ; and when we enquire 
how often it succeeds in our own country, 
as more nearly concerning us, we find that 
it has uniformly been fatal, that is, that all 
the patients have died from it ; there is not ' 
a single solitary instance of recovery. It 
has been performed in London, Leicester, 
Edinburgh, and Manchester, by the best 
surgeons of these places, and there are none 
better in the world ; but all the patients 
have died. Nevertheless, whenever the 
operation is performed, it should be done 
with a view of preserving both lives, be- 
cause it is a safer way of delivery to open 
the head of the child. In mollites ossium, 
indeed, the disease is continually going on ; 
no case recovers ; it always destroys the 
woman : and here it is certainly advisable 
to perform the Caesarean operation, though 
not with the hope of preserving both lives ; 
but that the woman is hardly more sure of 
dying after the operation has been perform- 
ed, than she was before. 
In all cases of mollities ossium, then, the 
child being ascertained to be alive, the Cm- 
sarean section should be performed ; in all 
other cases the life of the child should give 
way to that of the mother : and the head 
should be opened. 
Signs whether the Child he alive or dead. 
From the reluctance that every one must 
feel in opening the head of a child, it will 
be still a satisfaction to us to know whe- 
ther it be alive or dead. The marks, then, 
are these : in the first place, supposing the 
child is alive, the pregnancy of the mother 
will continue to increase to the end of her 
time; and in labour the presenting parte 
