695 
PARTURITION. 
it may be adopted. The fpace gained has been differently 
ftated at from three to eight or nine lines in the diameter ; 
the‘medium diftance would probably be fufficient to ac- 
complifli the delivery by the crotchet. 
“The objediions urged againft this mode of delivery, 
when the head is of the full fize, will not apply to its 
reduced bulk; and it fhould be remembered, that the 
fymphyfis is formed of cartilage and ligament; fo that 
whatever prefi'ure (hall be made againft the divided 
edges, will not be made againft the (harp angles of bone. 
That much injury may be done anteriorly will not be de¬ 
nied ; but, does the continued prefi'ure of the child’s 
head never produce mifchief in other cafes ? By the in¬ 
troduction of a female found for a guide, a cautious and 
fteady operator will avoid wounding the urethra ; and, 
as the bafeof the fkull will probably be turned Tideways, 
it will fuffer lefs in extraction than in other cafes of the 
crotchet; in which it muft in general be injured from 
prefi'ure againft the pubis. If the feparation, however, 
be carried beyond a certain length, laceration will pro¬ 
bably enfue ; and, fhould this accident occur, I fee no 
reafon to apprehend more danger from it than follows 
the extraction of a large ftone from the bladder through 
a final 1 opening, which will induce a lacerated wound, 
but which we know will not uncommonly heal. The 
facro-iliac ligaments would certainly not be injured by 
choice, but the confequences, I believe, are not gene¬ 
rally fatal; and, fhould it be urged that great pain and 
lamenefs wall afflict the patient for a long time after, a 
reply will readily occur, that life was at flake; and 
furely there are few who would not compound, for the 
profpedt of temporary pain and inconvenience, to have 
itpreferved to them. 
“A fpontaneous feparation fometimes occurs, both 
there and at the pubis; and yet the patient has been 
again reftored to health. I do not fee, in other refpeCls, 
in what this compound operation differs from the moft 
difficult crotchet-cafe. The feCtion of the fymphyfis is 
neither fo formidable nor fo fatal as the Casfarian fec- 
tion ; and the crotchet has been fuccefsfully applied in 
dimenfions which will probably be thus acquired. 
“Upon the whole, then, in that fuppofed cafe of dif- 
tortion (which I hope will never happen) in which the 
mother muft be doomed to death, from the impoffibility 
of delivering the child by the crotchet, the compound 
operation I have recommended will furnifli a refource, 
approved by reafon and fandtioned by experience; inaf- 
much as the fedtion of the fymphyfis pubis has been 
made, and the crotchet has been ufed, though feparately, 
yet with fafety. Such a cafe will be attended, ur.quef- 
tionably, with additional hazard; but it offers the only 
chance to the mother, to the prefervation of whofe life 
our chief care fhould be diredted : and, I hope that in 
future all trace of the Casfarian operation will be ba- 
nifhed from profeffional books ; for it can never be jufti- 
fiable during the parent’s life, and Hands recorded only 
to difgrace the art.” 
We are aware that Mr. Simmons’s reafonings have been 
controverted by Dr. Hull, alfo of Manchefter, and by 
other perfons, (fee Mem. of the Med. Soc. p. 4.63.) and 
that the fedtion of the fymphyfis is very generally aban¬ 
doned by the profeffion. Indeed it never can be faid 
to have obtained here : and Dr. Merriman fays, that “ the 
remembrance of it can now be beneficial only as it may 
ferve to caution us againft the inconfiderate and hafty 
adoption of modes of pradtice, unfupported by juft reafon- 
ing, and unfandtioned by experience.” Yet we have 
been induced to give a fuller account of this pradtice in 
our pages; firftly, on account of the reafoning of Dr. 
Denman, which is favourable to it; and fecondly, be- 
caufe, though the current of profeffional opinion is now 
decidedly againft it, yet the tide may turn, and this 
operation may in time become again the fubftitute for 
that which we muft now proceed to deferibe. But, for a 
further account of the pradtice in cafes of extreme de¬ 
formity of the pelvis, the reader is referred to Ofborn’s 
EfTays ; Hamilton’s Letters to Ofborn ; Simmons’s Re- 
fledtions, and Hull’s Detedlion of Simmons. 
The Czesarian Section. —This is the name given to 
an operation which confifts in making an incilion through 
the parietes of the abdomen and uterus, fufficiently large 
to admit the introdudtion of the hand, and the extradlion 
of the feetus and placenta. 
The term cafarian is faid to be derived from the ope¬ 
ration “ ccrfo matris utero;” and Pliny even deduces the 
title of CceJ'ar, given to the Roman emperors, from one 
of them having been brought into the world by means of 
it. Whether this was the cafe or not, it feems not im¬ 
probable, from the prevalence of the opinion, that the 
operation had been performed prior to his time, (on the 
dead fubjedl,) although no account of it is to be found 
in the works of Hippocrates, Celfus, Paulus Asgineta, 
or Albucafis, who all of them treat largely on the mode 
of affifting in difficult parturition. The only method 
recommended by thefe writers for extradling the foetus 
when it was too large to pafs entire by the natural paflage, 
was to diminiih its bulk with fcalpels, or other cutting 
inftruments, and then to draw it away with hooks or 
crotchets ; a method, in fa£t, which is now followed, but 
with inftruments more artificially conftrudted, and thence 
lefs likely to injure the woman, than the more rude ones 
contrived by the ancients. 
The earlieft account we find of the casfarean fedtion in 
any medical work, is in the Chirurgia Guidonis de Cau- 
liaci, publifhed about the middle of the fourteenth cen¬ 
tury ; but the author only fpeaks of it as reforted to after 
the death of the woman, as was pradtifed, he fays, on the 
birth of Julius Crefar. Vigo, who was born towards the 
end of the 15th century, in the ffiort chapter he gives on 
difficult birth, takes no notice of this mode of delivery; 
and Pare, who greatly improved the pradtice of midwifery, 
thinks the operation only allowable on women who die 
undelivered. He had heard, he fays, not without afto- 
nifhment, of women who had been more than once fub- 
jedted to the csefarean fedtion, it not being pradticable 
to deliver them by any other means; but he confidered 
the operation as much too dangerous to be adopted. 
Roufl'et, however, who was contemporary with Pare, 
having colledted accounts of a number of cafes in which 
the operation was faid to have been fuccefsfully performed, 
publifhed, in 1581, 8vo. “ Traite nouveau de l’Hyfteroto- 
motokie, ou Enfantement Cefarien, qui eft l’extradtion de 
l’enfant par incifion laterale du ventre et de la matrice de 
la femme grofie, ne pouvant autrement accoucher ; et ce 
fans prejodicier a la vie de l’un et dekalitre, ni empecher 
la fecondite naturelle par apres.” But, though Roufl'et 
fpeaks with great confidence of the fafety of the opera¬ 
tion, and is warm in its recommendation, it does not ap¬ 
pear that he had ever feen it performed, or that more than 
one of the fix perfons, whofe cafes are related by him, 
were known to him. The book, however, foon became 
popular; and, being fome years after (viz. in 1601) tranf- 
lated into Latin by Cafpar Bauhine, with additional cafes 
and obfervations, it was quickly circulated over Europe. 
As this book is now become fcarce, we fliall diredt the 
reader’s attention to the Firft Part of the “Medical Re¬ 
cords and Refearches of a Private Afl'ociation, 1798.” in 
which there is An Inquiry by Dr. Haighton, concern¬ 
ing the Caefarian Operation ; which contains a review of 
fome authors who have written in fupport of that opera¬ 
tion, and the accuracy of whofe evidence appears very 
queftionable. Roufl'et is a principal objedt of Dr. H’s 
criticifm ; and, from the view here given of his credulity, 
his authority feems to be very light indeed. He men¬ 
tions one woman who had undergone the casfarean ope¬ 
ration Jeven times, and another who underwent it thrice. 
Another advocate for the fedtion relates, that a phyfician 
at Bruges performed this operation feven times on his 
own 
