Edgefield advertiser. [volume] (Edgefield, S.C.) 1836-current, 1871-10-19
A wonderful Case of Caesarean op.
.. - Grafton.


J. Walter Hill, of our town, we copy
from the Transactions of the South
Carolina Medical Association, Annual
Session, 1871" 1t is an unusual article to
be found in the columns of the Adverti-
ser, but as very valuable contribution
to science, no less than as well-merited
compliment to Physician whose skill,
experience, and constant study, should
be matter of pride in our community,
we do not hesitate to give it place. This
article and the operation it details have
excited immense interest among the
medical men Of the whole country. We
are informed that DR.. Hills skillful as
sistants in this difficult and wonderful
operation were Dr..W. D. Jennings and
DR.. II. w. Tompkins, also of our town:
On the 10th of October, 1869, 1 was
called at night to Margaret Gray, a colored
woman of pure race, about thirty years
of age, married, five feet high, well form
ed, in good health, and in her second la
abor. She had been in labor fifteen hours,
and informed me that twelve years pre-
viously she had difficult labor, which
lasted for six days. was unable to learn
the cause Of the protracted labor, but
upon examination the result was shown,
in total destruction to the perineum, in
contraction OF the vagina to a degree
which precluded a digital entrance, and
by firm, tense, unyielding membrane
OF cicatricial tissue, about one inch from
the ostium vagin9. Upon more careful
exploration, l found an oritice in this
cicatricial membrane which admitted a
No. 10 bougie; an adhesion of the urethra
half an inch from the meatus, which
made it impervious, and prevented the
introduction Of the catheter, and in ad-
dition vesico vaginal fistula. There was
no deformity of the pelvis. The woman
stated that Immediately following her
last labor there had been constant flow
of urine, over which she had no control.
Finding that the mouth OF the uterus
could not be reached in the usual way,
I mado rectal examination and found
the head presenting. a cavity between
the uterus and the cicatricial curtain clo-
sing the vagina at the external third,
could be readily felt with the finger in
the rectum. To enlarge the oriice in the
false vaginal mem brane, was III my Opin-
ion, the proper course; but wishing a
consultation, which could not be obtained
until morning, my patient was put under
influence of morphine and left for the
night.
On the day following, at eleven O. clock,
in consultation, it was agreed to make
such enlargement as would permit a
digital examination per vaginam. An
incision was made through the men,
brane which easily admitted the index
finger into the cavity beyond the obstruc-
ton, but the os uteri could not be found
by myself, nor by the consulting physi-
clan. Under these conditions, the labor
having now been in progress for twenty
eight hours without change, it was be-
lieved, from the condition of the parts
and the contraction of the vagina, that
delivery was impossible per Uias natu-
rates. IN consultation, it was decided
that the C;csarean section should be
performed.
Circumstances prevented my operating
until eleven o'clock the next day, Mt
which hour, the labor having not pro-
crossed further than the previous day,
chloroform was administered and the
operation for delivery was made in the
following way: BY careful incision
through the linea alba, commencing one
inch below the umbilicus and ending
two inches above tho symphisis pubs,
the abdominal cavity was exposed. The
peritoneum was incised to the same eX-
tent as the internal wound, and by eau.
tious strokes Of the knife, the cavity OF
the uterus was entered through an OPEN
ing sufficient for the extraction OF the
iptus. There was no liquor amnil, and
the left arm was found presenting direct
ly in the line of incision; the child was
removed without difficulty and cried
vigorously. The placenta attached to the
posterior portion of the funduS;, was I'M
mediatcly taken away, after the e1trac
ton of the CHI /, and tho hemorrhage,
which was considerable. forthwith ceased,
under the ready and firm contraction Of
the uterus. The line of incision was
brought together by seven deep inter-
ruptcd sutures passed through the abdom-
inal walls and the peritoneum. Long
strips of adhesive plaster were placed
between each suture, which still further
approximated the deep as well as super
fetal part of the wound. The dressing
was completed by applying compress
of carded cotton well saturated with car
bolic acid and glycerine, Zone part OF the
former to eight of the latter,) to the
whole length of the wound.
The patient did not show by the pulse
the effect of the chemorrhage incidental to
the incisions and the delivery of the
fetus and tho placenta, so, possibly, there
was not moro blood lost.than is usual in
a natural labor. The chlOrOform acted
most kindly, and after complete return
to consciousness, large dose of NOR
phine was given, and several portions
left with directions to my old nurse to
keep the woman under the influence of
the drug until I could again see her.
The compress of cotton was left undis-
turbed, EXCEPT that there was daily added
us much Of the carbolic mixture as it
would take UP, until the sixth day, when
it was removed. Union by first inten-
ton had taken place to the whole extent
of the incision, save half an inch at its
lowest part, which readily healed in
few days. Under the moderate influence
of morphine and light diet my patient
convalesced without an unfavorable
symptom, and had recovered sufficiently
to no long ger need my services after the
twelfth day succeeding the operation.
The great success obtained was due to
NV good fortune in having competent
assistant, who, by placing his hand on
either side of the line OF incision, with
the thumbs, extending across the upper
parts, kept the intestines well out OF the
way, and at the same time supported the
uterus steadily while the incisions were
being made, as well as during tho de-
livery Of the uterine contents.
It is now seventeen months since the
mother was delivered. She has contin
ued in good health, and attends to the
rough duties of alaborer household. The
child is wcll-formed, strong, vigorous
boy, better grown than most children of
his age.
Newspaper Change.
Welearn that at the close Of the pres
ent volume, November 1st, the Carolina
Farmer and Weekly Star, now combin-
ed, will be issued as separate publica-