History of turning. Turning, as it is generally practised at the present day, viz. changing the position of a living child so that the feet are brought down foremost into the vagina, was unknown to the ancients. There is little doubt, however, that if they could have been induced to have looked upon presentations of the nates and feet as natural labours, they would have been in possession of this valuable means of effecting artificial delivery; as it is, we meet with detached allusions to it in their writings, although applying only to cases where the child is dead. In the writings of Aspasia and Philumenus, which, but for the quotations of Œtius, would have been entirely lost to us, we find directions for turning the child. Thus, Philumenus states, “Si caput fœtûs locum obstruxerit ita ut prodire nequeat infans in pedes vertatur atque educatur.” At a still later period, Celsus gave similar directions, but to all appearance they also merely apply to a dead child. “Medici vero propositum est, ut infantem manu dirigat, vel in caput vel etiam in pedes si forte aliter compositus est;” and again he says, “Sed in pedes quoque conversus infans, non difficulter extrahitur. Quibus apprehensis per ipsas manus commode educitur.” (Celsus, de Medicinâ, lib. vii. cap. 29.)
From this time the whole subject seemed to sink into oblivion, until Pierre Franco, in his work on surgery[95] proposed the extraction of the child with the feet foremost: this was put into practice by the celebrated French surgeon, Ambrose Paré, (Ambr. Paræus, Opera Chirurgia, 1594,) who, nevertheless, recommended turning with the head foremost, where it was possible. His work was afterwards translated into Latin by Guillemeau, who, although he still adhered to the old plan of bringing down the head, showed the value of Paré’s mode of turning in hæmorrhages and convulsions. To Francis Mauriceau, a man of great learning and experience, we are indebted for this operation being greatly improved, by means of his valuable work, in 1668; but it is Philip Peu, in 1694, and William Manquest de la Motte, in 1721, to whom the merit is due of having pointed out the value of two great laws in turning—the one of not rupturing the membranes as already mentioned, the other of not attempting to push back the arm which presents.[96]
CHAPTER III.
CÆSAREAN OPERATION.
Indications.—Different modes of performing the operation.—History of the Cæsarean operation.
The next operation in Midwifery for delivering the full-grown fœtus alive is that of Hysterotomy, commonly called the Cæsarean operation, viz. where the fœtus is extracted through an artificial opening made through the parietes of the abdomen and uterus.
The indications for performing the operation are so different in this country to what they are elsewhere that they require especial mention: in England the operation is never performed upon the living subject except where the child cannot be delivered by the natural passage; under these circumstances it is scarcely undertaken in this country for the purpose of saving the child’s life, but merely that of the mother, it being considered preferable to deliver the child by perforation or embryotomy, even when known to be alive, than to expose the mother to so much suffering and danger.
On the Continent and also in America, it has not been considered in so dangerous a light as in this country, still less as an operation almost certainly fatal to the mother: therefore, besides being indicated as a means for preserving the mother’s life, it is performed for the purpose of saving the child’s life in cases where, by using the perforator, the child might be brought through the natural passages. The results of the Cæsarean operation have been so unfavourable, and the character of the process so frightful, as to have rendered it a measure of peculiar dread to practitioners, and in different times and countries the strongest feelings have been excited against it. By many of the celebrated authors of former times, viz. Ambrose Paré, Guillemeau, Dionis, &c. it was looked upon as altogether unjustifiable, and a similar opinion was entertained by many of our own countrymen at a much more recent period, (Dr. W. Hunter, Dr. Osborn, &c.)