The Caesarean section. / by Edward William Murphy.

  • Murphy, Edward William.
Date:
1859
Catalogue details

Licence: Public Domain Mark

Credit: The Caesarean section. / by Edward William Murphy. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    formed in precisely similar conditions, and a comparison of the facts and results will lead us much nearer to a just conclusion than any which may be derived from statistics at present both limited and imperfect. The cases, independently of mollities ossium, in which we might be called upon to decide upon the question which ope- ration should be preferred, are:—First, cases of extreme dis- tortion of the pelvis from rickets; secondly, pelvic tumours; and thirdly, the pelves of dwarfs. The rickety pelvis ge- nerally presents a deformity of one character; the promon- tory of the sacrum is pressed forward towards the symphysis pubis, which is rather expanded than otherwise; tlie cavity of the pelvis is shallow, and the outlet wide, but having the coccyx strongly bent forward. Want of space between the sa- crum and pubes and the projecting coccyx are the chief diffi- culties. If the former be overcome, the latter will not give much trouble; but cases sometimes are met with in which the antero-posterior measurement is so small that craniotomy be- comes an operation of extreme difficulty and danger, and the question naturally arises, whether, under such circumstances, the Caasarean section should not be preferred. It is such cases as these which lead to the question, what is the smallest space through which the child can be extracted from the pelvis? The space means that between the promontory of the sacrum and the pubes; and this has been laid down by different authors, according to their experience. Denman, who had witnessed the case of Elizabeth Sherwood, delivered by Dr. Osborne successfully, lays it down that “ if the cavity of the pelvis be so far closed that it should in any part very little exceed one inch [Elizabeth Sherwood’s was less], of which examples have sometimes occurred, we might presume that the head of the child, though it w^ere reduced to the least possible size, could not be extracted through it, and then the necessity and propriety of performing the Caesarean section would be allowed, whatever aversion we might have to it, especially if we had reason to think that the child was living, or to conclude that it was not dead”^. Osborne, who performed the opera- tion, fixes upon an inch and a half as the least space. Since then, authors have given minima vdiVymg from an inch to two inches^. In a case of this kind the comparative merits of either operation may be illustrated by two cases. In one, 3 Denman, p. 532. b Least conjngate measurement, according to Davis, linch; Hamilton, inch; Burns, l|inch; Hull, l|inch; Ramsbotham, l|-inch; Campbell, 2 inches; Dewees, 2 inches; Baudelocque, 2 inches, Frencli. B