CAESAREAN

SECTION  , in obstetrics (q.v.) the operation for removal of a foetus from the uterus by an abdominal incision, so called from a legend of its employment at the birth of Julius Caesar . This procedure has been practised on the dead mother since very early times; in fact it was prescribed by Roman law that every woman dying in advanced pregnancy should be so treated; and in 16o8 the senate of Venice enacted that any practitioner who failed to perform this operation on a pregnant woman supposed to be dead, laid himself open to very heavy penalties . But the first recorded instance of its being performed on a living woman occurred about 1500, when a Swiss pig-gelder operated on his own wife . From this time onwards it was tried in many ways and under many conditions, but almost invariably with the same result, the death of the mother . Even as recently as the first half of the 19th century the recorded mortality is over 50% . Thus it is no surprise that craniotomy—in which the life of the child is sacrificed to save that of the mother—was almost invariably preferred . As the use of antiseptics was not then understood, and as it was customary to return the uterus to the body cavity without suturing the incision, the immediate cause of death was either septicaemia or haemorrhage . But in 1882 Sanger published his method of suturing the uterus—that of employing two series of sutures, one deep, the other superficial . This method of procedure was immediately adopted by many obstetricians, and it has proved so satisfactory that it is still in use to-day . This, and the increasing knowledge of aseptic technique, has brought the mortality from this operation to less than 3 % for the mother and about 5% for the child; and every year it is being advised more freely for a larger number of morbid conditions, and with increasingly favourable results . Craniotomy, i.e. crushing the head of the foetus to reduce its size, is now very rarely performed on the living child, but symphysiotomy, i.e. the division of the symphysis pubis to produce a temporary enlargement of the pelvis, or caesarean section, is advocated in its place . Of these two operations, symphysiotomy is steadily being replaced by caesarean section .

This operation is now advised for (1) extreme degrees of pelvic contraction, (2) any malformation or

tumour of the uterus, cervix or vagina, which would render the birth of the child through the natural passages impossible, (3) maternal complications, as eclampsia and concealed accidental haemorrhage, and (4) at the death of the mother for the purpose of saving the child .