Chemical Changes Accompanying Muscular Activity
Authors: T. H. Milroy
Journal: BMJ (1927)

==~~~~~~~~~~~~~~~~~~~~~ã nd founded,-in 1784, a-lying-in hospital in which-about 100 women were delivered annually.Caesarean section in the eighteenth century was almost always fatal to the mother.In Ireland it had once suteceeded, and then it was performed by an ignorant nii (dwife, Mary Donally, in 1738-39; in England the first successful operation was performed by Barlow of Boltoni in 1793, and in that case the child did lnot survive.The operation was stigmatized by Oiild as a " detestable, barbarous, illegal piece of inhumanity."Although Smnellie and Burton in the middle of the century, and Hamilton and Denman at the end, had accepted the operation for cases of extreme pelvic contractioni, Osborn denied tllat -either Caesarean section or symphyseotomy was ever ta julstifiable operation.He described cases of the severest degree of polvic contraction in wxhich he had been able to dlelivei by means of craniotonmy, an(l, recognizing that the rlecovery of tho mother depended on its being performed before she became exhauisted, he extended the indica- tions to cases which perhaps might have beendelivered by foi-ceps, an(l therebv attracted a good deal of censure, especially from foreigni cbstetricianis, as the enthusiastic -advocate of mutilating opeerations.In favour of Osborn it must be, remenmbered that Caesarean section -and *symphyseotomy were at that time almfost unifor-mly fatal, th-at British obstetricians have always regarded the child's life as less valuable than the mother's, and that fatal r esults to the mother fronm craniiotomy depend almost entirely on its being performed too late.William Osborn, a friend and fellow lecturer of Deniman, was born in London in 1736.In 1770 he joined Denman in founding a school of midwifery, and became onie of the most success- fidl teachers, more than twelve hundred practitioners of midwifery having attended his lecturcs.For the performance of craniotomy either a guarded knife or scissors was employed, of which Smellie's scissors- perforator was the most practical.In the extraction of the chiild's head after perforationi the crochet was mostly used- -at first the straight instlrument, afterwards the curved crochet, and finially (by Smellie) the double crochet.Opinions differed as to whether the instrument should be fixed iniside or outside the skull.The forceps were also used for extracting the head (Smellie), or the forceps with a crochet at the enid of the blade (Pulgh).laemorrhages and Conviilsions.Telo liaemorrhages most frequentlv recorded at this period were of the ante-partum variety, due to separation of the placenta eitlher normallv situated or praevia.Giffard( was the first British author to point out the occuirrence of true placenta praevia, as distinguished from prolapse of the organ.The treatment was sometimes rup- ture of the membranes, but usually podalie version.Post- partum lhaemorrhage was treated mostly by sedatives anid tonics; but sometimes by local styptics, the disadvantages of which were recogilized.Cold applications were also employed.There is Ino record of the emp)loyment of manual compression of the uterus.Several cases of haemorrhage due to inversion of-the uterus are described, in some of whieh recovery followed the reduction of the inversion.A few cases of rupture of the uterus are menitioned; one of these is illustrated by Denman in a fine plate.Conivulsions were treated by bleeding, blistering, opiates (extract.or tinct.thebaic.),hot baths, and clysters.The temloral artery or jugular vein was often recolmmended as the vessel to be openied.Ectopic Gestation and llydatidiform Mole.