2nd June 2017, Volume 130 Number 1456

June 1917 

The following interesting case is extracted from the “Medical Essays of Edinburgh,” Vol. V., and cited in Smellie’s “Treatise on the Theory and Practice of Midwifery,” published in 1784. The Caesarian operation was performed with forceps by a midwife, and described by Mr. Duncan Stewart, Surgeon in Dungannon, in the County of Tyrone, Ireland.

“The histories of the Caesarian operation being so few, I send you the following. Alice O’Neale, aged about 33 years, wife to a poor farmer near Charlemont, and mother to several children, in January, 1738, was taken in labour, but could not be delivered of her child by several women who attempted it. She remained in this condition twelve days; the child was thought to be dead after the third day. Mary Donelly, an illiterate woman, but eminent among the common people for extracting dead births, being then called, tried also to deliver her in the common way, and her attempts not succeeding, performed the Caesarian operation by cutting with a razor, first the containing parts of the abdomen, and then the uterus, at the aperture of which she took out the child and secundines. The upper part of the incision was an inch higher, and to one side of the navel, and was continued downwards, in the middle betwixt the right os ilium and the linea alba. She held the lips of the incision together with her hand till one went a mile and returned with silk and the common needles which tailors use. With these she joined the lips in the manner of the stitch employed ordinarily for the hare-lip; and dressed the wound with whites of eggs, as she told me some days after, when led by curiosity I visited the poor woman who had undergone the operation. The cure was completed with salves of the midwife’s own compounding.

In about 27 days the patient was able to walk a mile on foot, and came to me in a farmer’s house, where she showed me the wound covered with a cicatrix; but she complained of her belly hanging outwards on the right side, where I observed a tumour as large as a child’s head; and she was distressed with a fluor albus, for which I gave her some medicines, and advised her to drink concoctions of the vulnerary plants, and to support the side of her belly with a bandage. The patient has enjoyed very good health ever since, manages her family affairs, and has frequently walked to market in this town, which is six miles distant from her own house.”

Report of a case of the Caesarian operation performed by Mr. Smith, a surgeon in Edinburgh:—

“I was sent for to Mrs. Paterson, a drummer’s wife in the Cannongate, June 28, 1737, about ten at night, who had been in labour for six days. She was one of the least women I ever saw, and prodigiously deformed.

I touched her and found something in the vagina so large that I at first took it for the head of the child; but soon found I was mistaken, for examining more attentively, I found, towards the os pubis, the os uteri thick, high, and a very little dilated, and through it I felt distinctly the child’s head. What I first took for it proved to be the os coccygis of a very extraordinary size and shape, turned inwards, quite across the vagina, and reaching almost to the fore part of it …… At the operation the following gentlemen were present:—Dr. Monro, Professor of Anatomy; Dr. John Lermont, Dr. James Dundas, Mr. Drummond, Mr. Osburn, Mr. Gibson, Mr. Douglas, surgeons. The instruments and dressings as follow:—1. A common scalpel. 2. A pair of crooked scissors. 3. Two needles threaded. 4. Four large needles threaded for the gastroraphia. 5. Scraped lint. 6. A large compress, napkin and scapulary. 7. Ink. 8. A cordial to be given during the operation.

The patient was laid on her back on a table covered with blankets with a pillow below her head. Her body being secured, I seated myself at her right side. I drew a line with ink about six inches in length parallel to the linea alba, and four inches distant from it, in order to avoid cutting the rectus muscle. I then, with a convex scalpel, made an incision along the black line through the teguments and fat. In the middle of the section I gently cut through the muscles and peritoneum, so as to get in the forefinger of the left hand; upon which, with the crooked scissors I enlarged the wound upwards and downwards equal to the black line I had made on the skin. The epigastric artery was opened, which I immediately stitched. I then cut into the uterus and tore the membranes containing the child, but as the child was large I found the incision in the abdomen too small; I was obliged to enlarge it upwards to the short ribs, and downwards to the os pubis, the uterus in proportion. I then extracted the child without any violence, afterward the placenta and membranes. I put my hand again into the uterus and brought away some coagulated blood. The child was dead, but quite fresh. I reduced a little of the gut that came down, and made the gastroraphia at three stitches without any peg. After the first stitch the gut gave me no more trouble. I covered the wound with moist pledgets, applied a large compress, and over all the napkin and scapulary. The poor woman bore the operation with great courage. After she was put to bed she took a quieting draught with landanum, and a bottle of emulsion for ordinary drink. She did not lose above four or five ounces of blood during the operation. In the night she bled a little, but it stopped before I got to her; she had not slept, but otherwise she was tolerably well. Next day I visited her, and she told me she had had some slumber in the morning. About twelve o’clock she complained of sickness at her stomach with an inclination to vomit; her pulse was then very frequent and small. She gradually grew weaker and weaker, and died about four in the afternoon. There came not away above two teaspoonfuls of blood from the vagina; the uterus was at least one inch and a half thick.”

Pliny, in his “Natural History,” states that Caesar was so called from being taken by incision out of the womb of his mother, and that such persons were called Caesones. This statement, however, is regarded as extremely doubtful. Tradition ascribes to Numa Pompilius a decree that every pregnant woman who died should be opened, and in 1608 the Senate of Venice decreed heavy penalties for medical practitioners who failed to perform this operation upon women dying in advanced pregnancy, and in 1749 a similar law was made by the King of the Two Siciles. The classical case in literature, of course, is that in Macbeth:—

Macb.—I bear a charmed life, which must not yield
          To one of woman born.

Macd.—Despair they charm:
          And let the angel whom thou still has served
          Tell thee, Macduff was from his mother’s womb
          Untimely ripped.