Cesarean Operation. By John Travis, M. D., of Mansfield,
Tennessee.
The Cesarian Operation is a rare one, and, when performed, it
has generally proved unsuccessful, more so in Europe than in
America.
In the year 1841, I was called to a lady aged 28 years, who
was in labor with her third child, which could not be delivered
in the ordinary way on account of malformation of the foetus. I
performed the operation in the usual manner, and the mother and
child are both living.
The mode of operation is so well described by authors, and so
generally understood by physicians, that a description here is
deemed unnecessary.
The case is briefly reported merely to show that it was successful.
We have inserted the above communication, more for the sake
of cautioning the younger members of the profession against the
dangerous doctrine it inculcates, than for any merit it possesses in
iteslf.
The author has stated that he performed what is confessedly
one of the most dangerous operations in surgery, upon a woman
having a well formed pelvis, (as witnessed by her two previous
labors,) merely on account of an unnamed malformation of the
foetus, and one too that did not compromise its life.
We aver, and in this we are supported by the highest authorities,
that no man has a right to perform this operation under any cir-
cumstances, unless it be clearly established that delivery per vias
naturales is more dangerous to the mother than the abdominal
section.
Cazeaux states “that the operation may be performed on the living
female, whenever the natural passages through which the child has
to pass are too narrow, or so obstructed, that a delivery by symphy-
siotomy, or the application of the forceps is, absolutely impossible ;
and. when the mutilation of the child itself, would not permit its
extraction without exposing the mother to the greatest dangers.”
Dr. Meigs says. “I should be glad, in the most emphatic man-
ner, to enter my protest upon the Records of Obstetrics, against the
Cesarean operation being performed with any other view than those
relative to the conservation of the mother, with the salvo always,
that to save the child is great additional good fortune. I believe
that he who performs the Cesarean section upon views relative
chiefly to the conservation of the foetus, flies in the face of the
soundest doctrine ; and I cannot understand how the conscience of
such an operator should ever be appeased under the pungent reflec-
tions that must follow a death not rendered inevitable by the exi-
gencies of the patient.”
Dr. Ramsbotham, in speaking on this subject, declares that “in the
British Isles, out of nearly thirty operations, we only have three in-
stances of recovery on record.” And further on: “ The fact is not
to be concealed, that in different parts of Europe, and especially in
Catholic countries, has the operation many times been had recourse
to, under circumstances in which no British practitioner would have
considered himself warranted in proposing it; where indeed there
has’existed sufficient available space in the pelvis to admit of the ex-
traction of the foetus per vias naturales.” And in a note he says : “ It
would be unfair to adduce in confirmation those cases in the latter half
of the sixteenth century, the second, third, fifth and sixth of Rousset,
which came under his own observation, and the ninth of Caspar Bau-
hine all which women brought forth live children, per vaginam sub-
sequently, even if they are correctly reported ; because they belong
to the age of barbarous surgery."” And still further on he says :
“ In Britian we never substitute it for craniotomy by choice, but
only have recourse to it when no other mode of delivery is practi-
cable.” p. 263.
Velpeau says, p. 506—“It may be stated, therefore, that up to
the present day, the Cesarean operation has proved fatal in at least
one out of five cases, and that Tennon was mistaken in asserting
that since the time of Bauhine, it has been performed at the Hotel
Dieu on seventy women, who recovered. By the report of J.
Burns and S. Cooper, it appears that not a single well attested case
of its successful performance has occurred in Great Britian, ah
though the number of operations amount to fifteen or twenty. I
think these details will suffice to exhibit the operation to young
practitioners in all its importance, and to prevent them from resort-
ing to it in any case, save when the necessity is absolute.”
Gooch declares that “the operation is performed only when the
deformity of the pelvis is so great, that even after perforating the
head and removing the bones of the cranium there is not sufficient
space for the extraction of what remains of the child.” p. 214.
These authorities, hastily collected, are in our opinion suffi-
cient to establish the danger of the operation, and to dissuade
any one from undertaking it, except under the circumstances
pointed out. But putting out of the question, the danger of the
mother, it should be remembered that the safety of the child is
also compromised, for the most stubborn advocates of the Cesarean
section are forced to acknowledge that they are not always fortu-
nate enough to extract a living child, even when the operation is
performed at the time of their own selection. And even should
the child survive, can it fill the void which is almost certain to be
created by the death of its parent ?
If we have censured the author of the above report unjustly,
we can only plead in justification, the meagre details with which
we are furnished; but as it now stands, we are compelled, both on
the ground of humanity and scientific surgery, to enter our
protest against the operation as unwarrantable, and our caution
lest others should “go and do likewise.”—Ed. Examiner.]