Observations on the Caesarean section and on other obstetric operations : with an appendix of cases.

  • Radford, Thomas, 1793-1881.
Date:
1865
Catalogue details

Licence: Public Domain Mark

Credit: Observations on the Caesarean section and on other obstetric operations : with an appendix of cases. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    fingers. The coccyx was considerably incurvated upwards and for- wards. The brim was tripartite in figure, or composed of three divi- sions. This altered shape was produced by the upper portion of the sacrum, and the last lumbar vertebrae standing so very much forwards and downwards, inclining a little more to the right side; and by the body of the ossa pubis and ischii being forced backwards and in- wards, and the rami and symphysis pubis jutting forwards. On the right side I could just place the point of the index finger, and on the left I could pass two fingers, one lying partially over the other.* Neither the presentation of the child nor the os uteri could be felt. Although my attendance was specially requested to explore the pelvis in anticipation of labour, and conclude on the measures which must be adopted when it supervened, we were compelled now to de- cide on her delivery, as she was and had been in labour since Mon- day, when the membranes must have ruptured, as I ascertained she had a dribbling watery discharge afterwards. We unanimously agreed that she could only be delivered by the Csesarean section. When we apprised this poor creature of our decision, she readily consented to submit to any plan we considered necessary. An enema was administered, but it did not act. The catheter was passed and about an ounce of urine withdrawn. Afterwards I placed the hand on the abdomen, and found still a fluctuant tumour, which induced me to pass a longer catheter, and, by a careful manipulation, it was carried higher, and succeeded in further removing a considerable quantity of urine. In the first place, we arranged the duty which each gentleman had to perform. Mr. Cheetham and Mr. Pigott joined us to witness the operation. I commenced to make the incision a little above the um- bilicus, on the left side of the linea alba, and extended it downwards towards the pubes, so as to be about six inches in length. In conse- quence of the very attenuated state of the abdominal parietes the uterus was at once exposed, and its tissues partially cut. It was necessary to raise the defected uterus upwards before the external incision was made. About a pint of water, with a large portion of intestines, now escaped. This portion of bowel, which had been dangerously exposed to be wounded, being drawn aside by Mr. Dunn, I fully divided the uterus in the line of the wound first made into it. The placenta was now exposed, the greater part of which lay to the right side of the incision and maintained its adherence; whilst that on the lefc (the smaller division) was separated by the contraction of the uterus. Mr. Dunn immediately passed his right hand in search of the feet of the infant, and his left along the body to guard its neck from being spasmodically seized during its abstraction (a caution given to him by me, having, in a previous case, met with this disaster). Having gained a firm hold of the feet of the infant, he very cautiously and expeditiously drew the body forth until the neck came to pass, which was then firmly grasped by the uterus, and the head thereby detained. The womb had an appearance as if it was indented, and strongly reminded us of its condition in hour-glass contraction. The difficulty at last being overcome, the infant (dead and partially putrid) was completely removed. The adherent por- tion of the placenta was detached, and wholly extracted. Not more than a few ounces of blood were lost. The intestines were much dis-