BY CHARLES JEWETT, A.M., M.D.,
Professor of Obstetrics and Diseases of Children, and Visiting Obstetrician, Long Island College Hospital; Physician-in-Chief to the Department of the Diseases of Children, St. Mary’s Hospital, Brooklyn.
THE IMPROVED CÆSAREAN SECTION.
Garrigues (Am. J. M. S., May, 1888,) describes in detail a successful case of Cæsarean section with observations on the technique of the improved operation. He prefers a long abdominal incision, and eventration of the uterus before opening it, the advantage claimed being the easier application of the rubber constrictor. The constrictor is more manageable if held in the hand of the assistant instead of the clamp, since it can be loosened and tightened as required. To prevent prolapse of intestines he sutures the upper end of the abdominal incision before turning out the uterus, tying the sutures before that organ is opened. Extraction of the fœtus by the head is much easier than by the feet. When a long uterine incision is required, it is better to go an inch into the fundus than to extend the wound into the lower segment, which may cause troublesome hæmorrhage.
Removal of the ovaries for the prevention of subsequent pregnancies he thinks not justified. The omentum he pushes up above the uterus to prevent adhesions to the suture line and the consequent danger of subsequent intestinal obstruction.
Dr. Garrigues believes Cæsarean section safer than difficult extraction through the natural passages.
Eleven Cæsarean sections were done in this country between December 16, 1886, and February 24, 1888, (Dr. R. P. Harris) all by the improved method but one. Six women and eight children were saved. Six of the operations were performed in hospitals, saving five women; five in private practice, saving only one. All the five hospital cases operated by the improved technique were successful. The bad results in private practice Dr. G. ascribes to imperfect antisepsis. He alludes to the tardy adoption by our own countrymen of the antiseptic methods in general obstetric practice which have met with almost universal acceptance elsewhere—in Germany midwives being even compelled by law to use antiseptic precautions in every case of confinement.
Including the above-mentioned case, one hundred and sixty-three Cæsarean sections had thus far been done in the United States (Harris). One hundred and seventy to date of this writing.—Ed.
The paper concludes with a detailed statement of the modus operandi and after-treatment in the modern Cæsarean operation. (A loop of the constrictor can usually be readily passed over the fundus and slipped down to the cervix while the uterus is still in the abdomen as we have shown.) (A Case of Cæsarean Section, N. Y. M. J., August 29, 1885.) Traction upon the constrictor perfectly occludes the short abdominal wound during the incision of the uterus, eventration taking place as the uterus collapses on removing the fœtus. The advantage, therefore, of extending the abdominal incision some inches above the umbilicus in all cases and turning out the uterus before opening it may be doubted. It is sometimes, however, impossible or difficult to apply the constrictor to the uterus in situ. Extraction of the fœtus by the head is certainly easier than delivery by the feet as advised by most writers.
The comparative results of induced labor, version, perforation and Cæsarean section in the Dresden Clinic have been recently considered in a series of papers by Leopold and his assistants, Korn, Lohman and Praeger.