Vol. 60, 1909 - University of North Carolina at Chapel Hill

XXVIII THE CHARLOTTE MEDICAL JOURNAL.
value of the pharmaceutical products of erable antiquity, and was put forward by 1
this series. some of the older Italian writers, who dis- i
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5. The author puts forth a method of cussed the advisability of the operation in
physiological assay, which is the result of the moribund state before death actually
nearly fifteen years of laboratory study, for occurred. A number of modern cases of
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consideration as a possible solution of this this kind has been recorded with a good re- !
problem. suit of the child.
Post-Mortem Caesarean Section.
The performance of a post-mortem Caesarean
section may fall to the lot of any
This operation is undoubtedly one of practitioner, and it is essential that he i
great antiquity, although it is difficult to should have clearly in his mind the condistate
at what period of time in the world's tions which would render such an underhistory
it was first performed. The /ex acg-fa taking justifiable. These may be postuof
Numa Pomilius, by which it was enacted lated shortly as follows: that the child
that in the case of a pregnant woman near should be viable and alive, that not more
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full term dying undelivered that body than twenty minutes should have elapsed '
should be opened immediately after death since the death of the mother, and that the i
and the child extracted, shows that it was possibility of a rapid delivery by the i
known to, and practiced by, the Romans natural passages should be out of the ques- i
With the spread of Christianity and of the tion.
rite of baptism, which gave to the life of An interesting case in this connection I
the unborn child an increased worth, the recently has been the subject of a coroner's
operation again came into favor, and in inquest in the town of St. Laurent in Can- i
the first half of the eighteenth century ada. A woman suffering from an abscess i
Pope Benedict issued a precept in which in the brain died during labor, and at the i
the indications for, and the precautions to order of the priest in attendance a midwife (
be observed in, its performance were duly performed post-mortem Caesarean section, I
set forth. it is said with a razor, and extracted a liv- *
As Hubert remarks, the Roman Catholic ing child who survives. The matter natur- i
Church reproduced the injunction of the ally occasioned a good deal of comment in ;
/fx rif^/a in the following decree of its ritual: a small town, and in view of the rumor i
"Si mater praegnans mortua sit, fructus which prevailed that the woman was not
quam primum caute extrahatur." At the dead at the time the operation was per- i
present day post-mortem Caesarean section formed the midwife was held by many to :
holds a definite place in the medical art and have committed murder. A post-mortem i
should undoubtedly be practiced in all cases examination, however, cleared up the cause ;
in which the chance of delivering the child of death and all the parties concerned were i
alive is present. In some countries indeed, exonerated. The performance of such an i
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for example, in the German States of Ba- ope ation by anyone but a properly quali- '
varia, Wurtemberg, and Saxony, the /ex fied medical man, especially in a case in
?rgia is still in force. In France and Eng- which the patient was not dead at the time i
laud the matter is left to the discretion of of the performance, might well expose the
the attendant physician, and as a natural persons concerned to a charge being preresult
in these countries the operation is
undertaken very infrequently.
ferred against them of manslaughter, if not
of murder.—The London Medical Lancet.
Modern statistics are, however, much
more encouraging—for example, 14 cases OiWicullics ot a Second Cesarean Sec-
collected by Bauer, 10 children were born ««" Repeated in tbe Same Woman. ,
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alive, and of 28 cases collected by Dicke A. Brindeau enumerates the possible comduring
the years 1875 to 190.3, 28 children plications of Cesarean section that may
were delivered alive, of whom 19 survived, render a second section more difficult and
The researches of Breslau and Runge dangerous in the same woman. Several
have demonstrated that the fetus is most operators have repeated the operation one
likely to survive for some length of time or more times in the same woman. The
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after the death of the mother when this has difficulties are hernia and eventration which
taken place suddenly. In cases of high rarely occur; adhesions; thinning of the
fever or of acute septic poisoning the fetus uterus at the point of the cicatrix; and adnot
infrequently dies before the mother, hesions of the placenta to the cicatrix.
The suggestion that in order to minimize Adhesions are quite frequent; they may be
the risk to the child the operation should be so slight that they are easily separated, or
performed on dying patients before a fatal so firm that it is impossible to enter the
issue actually results has found favor recently
amongst various obstetric writers.
This suggestion is one, however, of considuterus
without opening the peritoneal cavity.
The intestines may be involved in the adhesions,
or they may simulate ventrofixa- ;
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