Now we must remember that labour pains are not continual ; therefore we must not use the forceps as if they were. The head will not bear constant pressure, therefore we must desist every now and then, beginning with the least possible force that is of any use, which may be easily increased as may be necessary. We should rest frequently, and from time to time go round the head with our fin ger, to see how the business comes for ward; always satisfying ourselves that the instrument still encompasses the whole of the head. The motion we make with the forceps must be slow and gradual, in clining it very gently from side to side, or from blade to blade: always acting in a line, with the axis of the pelvis, till we can feel the occiput when we move with regard to the axis of the vagina ; using in the latter part of the operation ve ry little force, for the head requires very little force to bring it through the vagina.
Deformed Pelvis from Rickets or Mol lifies Ossium. In both these diseases the cavity of the pelvis is often so much contracted, that it is impossible for the child to be brought down it whole and alive by any means : and hence when we meet with deformity from either of these sources, our first question should be, whe ther there be space enough to allow the child's head to pass / and if the space be above three inches, it is sufficient; and the head may pass. Where it is less than three inches it is not sufficient, and the head cannot pass; the question is then changed, what method have we to bring the child out of the body, if it can not pass through the pelvis / and here it has been proposed to out it out from the body, by the following operation.
Croatian Section. This has been per formed in twd•ways, by an incision ob liquelycarried through the side;or through the lines alba directly down. The object proposed in this operation is to save the life both of the mother and child. It is of great antiquity. It is said that Julius Cesar was taken this way out of the bo dy of his mother; but there is no just ground for believing such a report; many historians held him as so remarkable a man, that they were determined he should not come into the world like any other person. if it had been so, is it not strange that Pliny, who wrote so soon afterwards, should devote a chapter entirely to the history of a living child being cut out of the holly of the parent who was dead, and yet mention nothing of Julius Casar's having come the same road. Sci pio Africanis is said to have been in troduced by the Caesarian section, but there is no reason to believe it. It was Never known otherwise than as an opera tion recommended till the sixth century in Paris. It was also once performed in Holland by a sow-gelder upon his wife. It is remarkable that the same woman was-afterwards pregnant; but when her husband proposed the operation again, she declined submitting to it, and was delivered without. The surgeon who strongly recommended it in Paris, was Rousset, who never lived to see it per formed, on account of the opposition he met with in opinion from Ambrose Parke and other eminent surgeons.
The manner of performing this opera tion has been much disputed ; the lateral incision appears to be the best ; because we divide one muscle, and it retracts, we divide the muscle under it, and it retracts also ; but the whole of the incision will not be a direct line through, so that we stand a better chance of saving our pa tient, as far as exclusion of the air may have a good effect, when the parts come afterwards to unite.
Of the two plans of performing the operation,the lateral incision then appears to be the best, and in making it we must attend to the following points: the woman may die ender the operation itself, or shortly after, from the loss of blood ; from exposure of the cavity of the abdo men, causing extensive peritoneal inflarn motion ; from the parts suppurating in stead of uniting by the first intention ; or from inflammation being so violent as to prevent the formation of matter produc ing mortification. Yet if we look at the cases of this kind that are recorded, we shall see the fairest accounts that could be written, the death of the patient never being attributed to the operation, but to some trifling cause, perhaps relating to diet ; such as a small glass of wine or a few grapes producing inflammation of the peritoneum, or diarrhcea. Tbis is decid ed upon, without considering the probabi lity that the diarrhoea or peritoneal inflam mation may have been produced by the operation alone. These things should be considered fairly, and not viewed with the partial eye of him who has performed the operation. We see that on the con tinent this operation has been very rarely successful, according to Bourdelet, not in one case out of ten : and when we en quire how often it succeeds in our own country, as more nearly concerning us, we find that it has uniformly been fatal, that is, that all the patients have died from it ; there is not a single solitary 'in stance of recovery. It has been perform ed in London. Leicester, Edinburgh, and Manchester, by the best surgeoni of these places, and there are none better in the world ; but all the patients have died. Nevertheless, whenever the operation is performed it should be done with a vie* of preserving both lives, because it is a safer way of delivery to open the head of the child. In mollifies ossium, indeed, the disease is continually going on ; no case recovers ; it always destroys the wo man : and here it is certainly advisable to perform the Caesarian operation, though not with the hope of preserving both lives ; but that the woman is hardly more sure of dying after the operation has been performed, than she was In all cases of mollifies ossi um, then, the child being ascertained to be alive, the Ciesarian section should be performed ; in all other cases the life of the child should give way to that of the mother, and the head should be opened.