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: 893