Further observations on the Caesarean section / by Thomas Radford.

Date:
1868
Catalogue details

Licence: Public Domain Mark

Credit: Further observations on the Caesarean section / by Thomas Radford. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    IO the organ, which is so important to produce a nice adaptation of the edges of the wound, and thereby, in some measure at least, to prevent it from assuming the gaping character which occurred in some of the tabu- lated cases. Labour unduly protracted, from any cause whatever, is nearly always attended or followed by some danger to either the mother or to her in- fant, or to both. The degree of mischief inflicted on the maternal structures is in general in a ratio proportioned to the period of protrac- tion ; and, doubtless, in all cases it is aggravated by the nature of the obstructing cause. We ought, therefore, to be extremely watchful, in all cases of protracted labour, but especially so when the impediment arises from a mechanical cause; and we should timely adopt appropriate measures for the delivery of the woman before irreparable mischief is done. (See former observations, British Medical Journal; also Cases of Laceration of the Uterus, etc., Obstetrical Transactions, Lon- don, vol. viii, p. aio.) In ordinary labours, where the infant can pass pervias naturales, cer- tain organic changes are waited for; the os uteri must be more or less dilated; but, in those cases which demand the Caesarean section, it is not only a very great folly to wait, as dilatation cannot be effected, but it is a very great evil. An early performance of the operation is of the utmost importance. Supposing the woman at full term of pregnancy, it should be com- menced as soon as the labour is declared—before, or at least immedi- ately after, the membranes are ruptured. By so doing, the uterine inci- sion would be relatively considerably diminished after the complete contraction of the uterus, and all the dangers of protraction avoided. My friend Dr. Greenhalgh has suggested the performance of this opera- tion before the completion of pregnancy. He says : “ I have a strong conviction that greater success would attend our endeavours if all cases were operated upon at, or shortly after the completion of, the eighth month of utero-gestation, when the vessels are smaller, the contractile power of the uterus greater, and the liquor amnii relatively larger in proportion to the size of the child. By pursuing such a course, a smaller incision would be required, less blood would be lost.” I am inclined to agree with the above suggestion, especially if the obstructing cause of labour be epithelioma of the os or cervix uteri. Two successful cases are recorded (p. 14) in which the operation was performed before the completion of pregnancy— one at the end of the eighth month, by Dr. Greenhalgh; the other at six and a half to seven months, by Dr. New- man. There is, however, one objection, cither real or imaginary,