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The Ephemerides gives examples of the child hiccoughing in the uterus.Cases of crying before delivery, some in the vagina, some just before the complete expulsion of the head from the os uteri, are very numerous in the older writers; and it is quite possible that on auscultation of the pregnant abdomen fetal sounds may have been exaggerated into cries. Bartholinus, Borellus, Boyle, Buchner, Paullini, Mezger, Riolanus, Lentillus, Marcellus Donatus, and Wolff all speak of children crying before delivery; and Mazinus relates the instance of a puppy whose feeble cries could be heard before expulsion from the bitch. Osiander fully discusses the subject of infants crying during parturition.
McLean describes a case in which he positively states that a child cried lustily in utero during application of the forceps. He compared the sound as though from a voice in the cellar. This child was in the uterus, not in the vagina, and continued the crying during the whole of the five minutes occupied by delivery.
Cesarean Section.--Although the legendary history of Cesarean section is quite copious, it is very seldom that we find authentic records in the writings of the older medical observers. The works of Hippocrates, Aretxeus, Galen, Celsus, and Aetius contain nothing relative to records of successful Cesarean sections. However, Pliny says that Scipio Africanus was the first and Manlius the second of the Romans who owed their lives to the operation of Cesarean section; in his seventh book he says that Julius Caesar was born in this way, the fact giving origin to his name. Others deny this and say that his name came from the thick head of hair which he possessed. It is a frequent subject in old Roman sculpture, and there are many delineations of the birth of Bacchus by Cesarean section from the corpse of Semele. Greek mythology tells us of the birth of Bacchus in the following manner: After Zeus burnt the house of Semele, daughter of Cadmus, he sent Hermes in great haste with directions to take from the burnt body of the mother the fruit of seven months. This child, as we know, was Bacchus. Aesculapius, according to the legend of the Romans, had been excised from the belly of his dead mother, Corinis, who was already on the funeral pile, by his benefactor, Apollo; and from this legend all products of Cesarean sections were regarded as sacred to Apollo, and were thought to have been endowed with sagacity and bravery.
Old records tell us that one of the kings of Navarre was delivered in this way, and we also have records of the birth of the celebrated Doge, Andreas Doria, by this method. Jane Seymour was supposed to have been delivered of Edward VI by Cesarean section, the father, after the consultation of the physicians was announced to him, replying: "Save the child by all means, for I shall be able to get mothers enough." Robert II of Scotland was supposed to have been delivered in this way after the death of his mother, Margery Bruce, who was killed by being thrown from a horse. Shakespere's immortal citation of Macduff, "who was from his mother's womb untimely ripped," must have been such a case, possibly crudely done, perchance by cattle-horn. Pope Gregory XIV was said to have been taken from his mother's belly after her death. The Philosophical Transactions, in the last century contain accounts of Cesarean section performed by an ignorant butcher and also by a midwife; and there are many records of the celebrated case performed by Jacob Nufer, a cattle gelder, at the beginning of the sixteenth century.
By the advent of antisepsis and the improvements of Porro and others, Cesarean section has come to be a quite frequent event, and a record of the successful cases would hardly be considered a matter of extraordinary interest, and would be out of the province of this work, but a citation of anomalous cases will be given. Baldwin reports a case of Cesarean section on a typical rachitic dwarf of twenty-four, who weighed 100 pounds and was only 47 1/2 inches tall. It was the ninth American case, according to the calculation of Harris, only the third successful one, and the first successful one in Ohio. The woman had a uniformly contracted pelvis whose anteroposterior diameter was about 1 1/4 inches. The hygienic surroundings for the operation were not of the best, as the woman lived in a cellar. Tait's method of performing the operation was determined upon and successfully performed. Convalescence was prompt, and in three weeks the case was dismissed. The child was a female of 7 1/2 pounds which inherited the deformities of its mother. It thrived for nine and a half months, when it died of angina Ludovici. Figure 15 represents the mother and child.
Harris gives an account of an operation upon a rachitic dwarf who was impregnated by a large man, a baby weighing 14 pounds and measuring 20 inches being delivered by the knife. St. Braun gives the account of a Porro-Cesarean operation in the case of a rachitic dwarf 3 feet 10 inches tall, in which both the mother and child recovered. Munde speaks of twins being delivered by Cesarean section. Franklin gives the instance of a woman delivered at full term of a living child by this means, in whom was also found a dead fetus. It lay behind the stump of the amputated cervix, in the culdesac of Douglas. The patient died of hemorrhage.
Croston reports a case of Cesarean section on a primipara of twenty-four at full term, with the delivery of a double female monster weighing 12 1/2 pounds. This monster consisted of two females of about the same size, united from the sternal notch to the navel, having one cord and one placenta. It was stillborn. The diagnosis was made before operation by vaginal examination. In a communication to Croston, Harris remarked that this was the first successful Cesarean section for double monstrous conception in America, and added that in 1881 Collins and Leidy performed the same operation without success.
Instances of repeated Cesarean section were quite numerous, and the pride of the operators noteworthy, before the uterus was removed at the first operation, as is now generally done. Bacque reports two sections in the same woman, and Bertrandi speaks of a case in which the operation was successfully executed many times in the same woman. Rosenberg reports three cases repeated successfully by Leopold of Dresden. Skutsch reports a case in which it was twice performed on a woman with a rachitic pelvis, and who the second time was pregnant with twins; the children and mother recovered. Zweifel cites an instance in which two Cesarean sections were performed on a patient, both of the children delivered being in vigorous health. Stolz relates a similar case. Beck gives an account of a Cesarean operation twice on the same woman; in the first the child perished, but in the second it survived. Merinar cites an instance of a woman thrice opened. Parravini gives a similar instance. Charlton gives an account of the performance carried out successfully four times in the same woman; Chisholm mentions a case in which it was twice performed. Michaelis of Kiel gives an instance in which he performed the same operation on a woman four times, with successful issues to both mother and children, despite the presence of peritonitis the last time. He had operated in 1826, 1830, 1832, and 1836. Coe and Gueniot both mention cases in which Cesarean section had been twice performed with successful terminations as regards both mothers and children. Rosenberg tabulates a number of similar cases from medical literature.
Cases of Cesarean section by the patient herself are most curious, but may be readily believed if there is any truth in the reports of the operation being done in savage tribes. Felkin gives an account of a successful case performed in his presence, with preservation of the lives of both mother and child, by a native African in Kahura, Uganda Country. The young girl was operated on in the crudest manner, the hemorrhage being checked by a hot iron. The sutures were made by means of seven thin, hot iron spikes, resembling acupressure-needles, closing the peritoneum and skin. The wound healed in eleven days, and the mother made a complete recovery. Thomas Cowley describes the case of a negro woman who, being unable to bear the pains of labor any longer, took a sharp knife and made a deep incision in her belly--deep enough to wound the buttocks of her child, and extracted the child, placenta and all. A negro horse-doctor was called, who sewed the wound up in a manner similar to the way dead bodies are closed at the present time.
Barker gives the instance of a woman who, on being abused by her husband after a previous tedious labor, resolved to free herself of the child, and slyly made an incision five inches long on the left side of the abdomen with a weaver's knife. When Barker arrived the patient was literally drenched with blood and to all appearance dead. He extracted a dead child from the abdomen and bandaged the mother, who lived only forty hours. In his discourses on Tropical Diseases Moseley speaks of a young negress in Jamaica who opened her uterus and extracted therefrom a child which lived six days; the woman recovered. Barker relates another case in Rensselaer County, N.Y., in which the incision was made with the razor, the woman likewise recovering. There is an interesting account of a poor woman at Prischtina, near the Servian frontier, who, suffering greatly from the pains of labor, resolved to open her abdomen and uterus. She summoned a neighbor to sew up the incision after she had extracted the child, and at the time of report, several months later, both the mother and child were doing well.
Madigan cites the case of a woman of thirty-four, in her seventh confinement, who, while temporarily insane, laid open her abdomen with a razor, incised the uterus, and brought out a male child. The abdominal wound was five inches long, and extended from one inch above the umbilicus straight downward. There was little or no bleeding and the uterus was firmly contracted. She did not see a physician for three hours. The child was found dead and, with the placenta, was lying by her side. The neighbors were so frightened by the awful sight that they ran away, or possibly the child might have been saved by ligature of the funis. Not until the arrival of the clergyman was anything done, and death ultimately ensued.
A most wonderful case of endurance of pain and heroism was one occurring in Italy, which attracted much European comment at the time. A young woman, illegitimately pregnant, at full term, on March 28th, at dawn, opened her own abdomen on the left side with a common knife such as is generally used in kitchens. The wound measured five inches, and was directed obliquely outward and downward. She opened the uterus in the same direction, and endeavored to extract the fetus. To expedite the extraction, she drew out an arm and amputated it, and finding the extraction still difficult, she cut off the head and completely emptied the womb, including the placenta. She bound a tight bandage around her body and hid the fetus in a straw mattress. She then dressed herself and attended to her domestic duties. She afterward mounted a cart and went into the city of Viterbo, where she showed her sister a cloth bathed in blood as menstrual proof that she was not pregnant. On returning home, having walked five hours, she was seized with an attack of vomiting and fainted. The parents called Drs. Serpieri and Baliva, who relate the case. Thirteen hours had elapsed from the infliction of the wound, through which the bulk of the intestines had been protruding for the past six hours. The abdomen was irrigated, the toilet made, and after the eighteenth day the process of healing was well progressed, and the woman made a recovery after her plucky efforts to hide her shame.
Cases like the foregoing excite no more interest than those on record in which an abdominal section has been accidental, as, for instance, by cattle-horns, and the fetus born through the wound. Zuboldie speaks of a case in which a fetus was born from the wound made by a bull's horn in the mother's abdomen. Deneux describes a case in which the wound made by the horn was not sufficiently large to permit the child's escape, but it was subsequently brought through the opening. Pigne speaks of a woman of thirty-eight, who in the eighth month of her sixth pregnancy was gored by a bull, the horn effecting a transverse wound 27 inches long, running from one anterior spine to the other. The woman was found cold and insensible and with an imperceptible pulse. The small intestines were lying between the thighs and covered with coagulated blood. In the process of cleansing, a male child was expelled spontaneously through a rent in the uterus. The woman was treated with the usual precautions and was conscious at midday. In a month she was up. She lived twenty years without any inconvenience except that due to a slight hernia on the left side. The child died at the end of a fortnight.
In a very exhaustive article Harris of Philadelphia has collected nearly all the remaining cases on record, and brief extracts from some of them will be given below. In Zaandam, Holland, 1647, a farmer's wife was tossed by a furious bull. Her abdomen was ripped open, and the child and membranes escaped. The child suffered no injuries except a bruised upper lip and lived nine months. The mother died within forty hours of her injuries. Figure 19 taken from an engraving dated 1647, represents an accouchement by a mad bull, possibly the same case. In Dillenberg, Germany, in 1779, a multipara was gored by an ox at her sixth month of pregnancy; the horn entered the right epigastric region, three inches from the linea alba, and perforated the uterus. The right arm of the fetus protruded; the wound was enlarged and the fetus and placenta delivered. Thatcher speaks of a woman who was gored by a cow in King's Park, and both mother and child were safely delivered and survived.
In the Parish of Zecoytia, Spain, in 1785, Marie Gratien was gored by an ox in the superior portion of her epigastrium, making a wound eight inches long which wounded the uterus in the same direction. Dr. Antonio di Zubeldia and Don Martin Monaco were called to take charge of the case. While they were preparing to effect delivery by the vagina, the woman, in an attack of singultus, ruptured the line of laceration and expelled the fetus, dead. On the twenty-first day the patient was doing well. The wound closed at the end of the sixteenth week. The woman subsequently enjoyed excellent health and, although she had a small ventral hernia, bore and nursed two children.
Marsh cites the instance of a woman of forty-two, the mother of eight children, who when eight months pregnant was horned by a cow. Her clothes were not torn, but she felt that the child had slipped out, and she caught it in her dress. She was seen by some neighbors twelve yards from the place of accident, and was assisted to her house. The bowels protruded and the child was separated from the funis. A physician saw the woman three-quarters of an hour afterward and found her pulseless and thoroughly exhausted. There was considerable but not excessive loss of blood, and several feet of intestine protruded through the wound. The womb was partially inverted through the wound, and the placenta was still attached to the inverted portion. The wound in the uterus was Y-shaped. The mother died in one and a half hours from the reception of her injuries, but the child was uninjured.
Scott mentions the instance of a woman thirty-four years old who was gored by an infuriated ox while in the ninth month of her eighth pregnancy. The horn entered at the anterior superior spinous process of the ilium, involving the parietes and the uterus. The child was extruded through the wound about half an hour after the occurrence of the accident. The cord was cut and the child survived and thrived, though the mother soon died. Stalpart tells the almost incredible story of a soldier's wife who went to obtain water from a stream and was cut in two by a cannonball while stooping over. A passing soldier observed something to move in the water, which, on investigation, he found to be a living child in its membranes. It was christened by order of one Cordua and lived for some time after.
Postmortem Cesarean Section.--The possibility of delivering a child by Cesarean section after the death of the mother has been known for a long time to the students of medicine. In the olden times there were laws making compulsory the opening of the dead bodies of pregnant women shortly after death. Numa Pompilius established the first law, which was called "les regia," and in later times there were many such ordinances. A full description of these laws is on record. Life was believed possible after a gestation of six months or over, and, as stated, some famous men were supposed to have been born in this manner. Francois de Civile, who on great occasions signed himself "trois fois enterre et trois fois par le grace de Dieu ressucite," saw the light of the world by a happy Cesarean operation on his exhumed mother. Fabricius Hildanus and Boarton report similar instances. Bourton cites among others the case of an infant who was found living twelve hours after the death of his mother. Dufour and Mauriceau are two older French medical writers who discuss this subject. Flajani speaks of a case in which a child was delivered at the death of its mother, and some of the older Italian writers discuss the advisability of the operation in the moribund state before death actually ensues. Heister writes of the delivery of the child after the death of the mother by opening the abdomen and uterus.
Harris relates several interesting examples. In Peru in 1794 a Sambi woman was killed by lightning, and the next day the abdomen was opened by official command and a living child was extracted. The Princess von Swartzenberg, who was burned to death at a ball in Paris in 1810, was said to have had a living child removed from her body the next day. Like all similar instances, this was proved to be false, as her body was burned beyond the possibility of recognition, and, besides, she was only four months pregnant. Harris mentions another case of a young woman who threw herself from the Pont Neuf into the Seine. Her body was recovered, and a surgeon who was present seized a knife from a butcher standing by and extracted a living child in the presence of the curious spectators. Campbell discusses this subject most thoroughly, though he advances no new opinions upon it.
Duer tabulates the successful results of a number of cases of Cesarean section after death as follows:--
Date: 2014-12-29; view: 984
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