Garrigues (Am. J. M. S., May, 1888,) describes in detail a successful
case of Cæsarean section with observations on the _technique_ of the
improved operation. He prefers a long abdominal incision, and
eventration of the uterus before opening it, the advantage claimed being
the easier application of the rubber constrictor. The constrictor is
more manageable if held in the hand of the assistant instead of the
clamp, since it can be loosened and tightened as required. To prevent
prolapse of intestines he sutures the upper end of the abdominal
incision before turning out the uterus, tying the sutures before that
organ is opened. Extraction of the fœtus by the head is much easier than
by the feet. When a long uterine incision is required, it is better to
go an inch into the fundus than to extend the wound into the lower
segment, which may cause troublesome hæmorrhage.
Removal of the ovaries for the prevention of subsequent pregnancies he
thinks not justified. The omentum he pushes up above the uterus to
prevent adhesions to the suture line and the consequent danger of
subsequent intestinal obstruction.
Dr. Garrigues believes Cæsarean section safer than _difficult_
extraction through the natural passages.
Eleven Cæsarean sections were done in this country between December 16,
1886, and February 24, 1888, (Dr. R. P. Harris) all by the improved
method but one. Six women and eight children were saved. Six of the
operations were performed in hospitals, saving five women; five in
private practice, saving only one. All the five hospital cases operated
by the improved technique were successful. The bad results in private
practice Dr. G. ascribes to imperfect antisepsis. He alludes to the
tardy adoption by our own countrymen of the antiseptic methods in
general obstetric practice which have met with almost universal
acceptance elsewhere—in Germany midwives being even compelled by law to
use antiseptic precautions in every case of confinement.
Including the above-mentioned case, one hundred and sixty-three Cæsarean
sections had thus far been done in the United States (Harris). One
hundred and seventy to date of this writing.—ED.
The paper concludes with a detailed statement of the _modus operandi_
and after-treatment in the modern Cæsarean operation. (A loop of the
constrictor can usually be readily passed over the fundus and slipped
down to the cervix while the uterus is still in the abdomen as we have
shown.) (A Case of Cæsarean Section, N. Y. M. J., August 29, 1885.)
Traction upon the constrictor perfectly occludes the short abdominal
wound during the incision of the uterus, eventration taking place as the
uterus collapses on removing the fœtus. The advantage, therefore, of
extending the abdominal incision some inches above the umbilicus in all
cases and turning out the uterus before opening it may be doubted. It is
sometimes, however, impossible or difficult to apply the constrictor to
the uterus in situ. Extraction of the fœtus by the head is certainly
easier than delivery by the feet as advised by most writers.
The comparative results of induced labor, version, perforation and
Cæsarean section in the Dresden Clinic have been recently considered in
a series of papers by Leopold and his assistants, Korn, Lohman and
Praeger.
The maternal mortality was as follows:
Induced premature labor 2.2 per cent.
Version and extraction 4–8 per cent.
Perforation 2–8 per cent.
Cæsarean section 8–6 per cent.