THE POST-MORTEM CIESAREAN SECTION.
it would seem as though there could be no doubt as to the necessity of practising this operation, whenever, after the twenty-eighth week of pregnancy, the mother dies, and tho living child cannot be extracted by the natural passages, or only after delay which' would compromise its life. There are, however, two circumstances which modify this law, so natural and obligatory, leaving out of question the re ligious point of view. 1. We possess, at present, no absolute timely sign on which we may rely as pointing to the maternal death, and as Naegele and Grenser put it, " aside from the cases where death results from pro longed 'disease, typhoid, phthisis, etc., where we are in no doubt as to the cessation of life, it will never perhaps be possible to obtain certainty of death at a time when the section should be made in order to save the foetus." There are further a number of cases recorded where the opera tion has been performed on women in a state of apparent death, such as those of Peu, Trinchinetti, Reinhardt, Bodin, d'Outrepont, etc.
2. We do not know exactly the time which may elapse after the mother expires before the foetus dies.
The results of the operation are not very satisfactory. According to Heymann and Lange, in 331 operations, only 6 to 7 children were saved, and 13 lived but a few hours; according to Schwartz, in 107 operations, performed in the electorate of Heise, not one child was saved.
Breslau, on the other hand, who has made experiments on animals, deduces the following conclusions: 1. There can be no doubt but that the foetus, human as well as animal, survives the mother when death has been sudden, as in hemorrhage, as phyxia, apoplexy, etc.
2. The human foetus survives the sudden maternal death longer than the animal foetus.
3. The section is not likely to save the child if performed beyond fif teen to twenty minutes after the maternal death. The best known cases are those of Pingler, the infant extracted alive, fifteen minutes after the maternal death, and lived 32 minutes; infant extracted 23 minutes after, and survived; Breslau, extraction 15 minutes after, and lived a few hours; Brotheston, 23 minutes, infant lived; Hoscheck, a few minutes, infant lived; Campbell, 10 minutes, infant lived 14 years.
4. If the mother dies of an essential fever, we cannot hope to save the infant, because its life-supplies have not been cut off suddenly, but little by little. The same holds true of poisoning by substances which deter mine rapid decomposition of the blood, such as prussic acid. Death from chloroform seems to be an exception, because it does not seem to penetrate into the circulation of the infant.
Breslau adds, " the duty of every physician is always, as soon as the mother's death is established, to resort to the Caesarean section, unless, indeed, the fcetus be dead before the mother, or where we can extract it more readily by the natural passages." (Naegele and Grenser.) [There is a natural repugnance in the mind of every one towards allow ing the mother's body to act as the infant's coffin. Even, therefore, where the death of the foetus antedates that of the mother, it is more ap propriate to extract the fcetus by section, except, of course, where this is possible per vias naturales.- -Ed.] Extraction by the natural passages has been advocated by Naegele and Grenser, and by Thevenot, and we pass briefly to the study of the ques tion.