.THE.. LOUISVILLE MONTHLY JOURNAL OF MEDICINE AND SURGERY. VOLUME 10. LOUISVILLE, JUNE, 1903. NUMBER 1. Original Communications. CESAREAN SECTION.* BY J. GARLAND SHERRILL, M.D., Professor of Surgery, Kentucky University, Medical Department. LOUISVILLE, KY. This operation has been practiced since 1498, when Jacob Nufer, a butcher, of Switzerland, successfully performed it upon his own wife. The first treatise upon the subject was written by Rousset, 1581, and the operation was strongly opposed by Ambrose Pare and others. Trautman, of Wittenberg, in 1610, was the first physician to employ this method of delivery. Since then, with improved technique, the decreasing mortality has broadened the indications for the operation, and within the past few years it has been proposed in the treatment of conditions in which it was formerly not considered. This is notably the case in placenta previa, for which condition the Cæsarean operation was first proposed by Huston Ford, of St. Louis, in 1892, and later † by A. Palmer Dudley,++ of New York, and by G. M. Boyd, of Philadelphia. These three authors have arrived at the same conclusion, which is that "Casarean section and the Porro operation are not only justifiable, but in reality indicated in complete and central ectopic implantation of the placenta. The maternal mortality in this condition, as usually treated, ranges from 16 Read before the Louisville Surgical Society, April 6, 1903. For discussion see page 31. to 40 %, and that of the child 50 to 83 %, as given by the different writers on the subject. In the face of such a high death rate, is it not surprising that a more satisfactory method of dealing with these cases is to be sought? It is claimed that the Cæsarean operation performed in such cases after the child is viable, to the exclusion of any other method of treatment, will save a much larger percentage of children than the usual methods of delivery. The plea is made by the advocates of this operation for placenta previa that the child has a claim upon life which ought not to be ignored. Personally, I believe this claim should be given great consideration, yet I believe the child should be known to be alive be fore the mother is subjected to this operation for placenta previa, except where fetus dead and uterus septic, as formance, is removed by the death of one of the chief reasons for its perthe child. Zinke, §§ of Cincinnati, says: "My own experience with the treatment of forty cases of placenta previa by tampon, separation of placenta around the cervix, forcible dilatation, version, and extraction contents, and of one case of Cæsarean section (Saenger method) convinced me that the latter procedure will accomplish the best results." He performed this section for marked cicatricial contractions in the vagina caused by a previous labor with the aid of version and craniotomy, the patient being the victim of a well pro Trans. Am. Asso. Obstetricians and Gynecologists. Vol. 14, 1901. Page 137. |