AN, OPERATION (Lat. p.p. ewsus, from ewdere, to cut. Popularly, but in all likelihood erroneously, connected with Cwsar). A name which has from very ancient times been applied to the operation of delivering a child through an abdominal incision into the pregnant uterus instead of by way of the natural passages. The operation is of very ancient date. It is supposed to have been practiced by the Greeks, and Pliny mentions that Scipio Africanus and Manlius were born in this way. Children delivered in this manner were known as Ctesones, and from this the name Cesar was subsequently derived as a family name.
A number of noted persons in history have had their names associated with the operation, as .,Eseulapius, Julius Caesar, and Edward Vl. of England. In the ease of the latter two, however, there seems to be very good evidence that birth was not accomplished in this manner.
There can be no question, however, that the operation was frequently practiced, and its performance was from time to time made a mat ter of statutory enforcement. Numa Pompilius decreed that every pregnant woman who died should be opened, and the Senate of Venice in 1608 decreed that practitioners should perform the operation, under heavy penalties, on preg,nant women supposed to be dead. In 1749 the King of Sicily imposed the punishment of death upon a medical man who neglected to operate on a dying woman advanced in pregnancy.
During these earlier days in the history of the operation it seems to have been practiced almost solely upon women just dead or at the point of death, and to have had for its purpose the saving of the infant alone. The first ease in which the
operation was performed on a living woman oc curred in 1491. Since this date many eases have from time to time been reported of both mother and child having survived the operation, and some of these under the most adverse circum stances. It is only since 1890, however, that the operation has come to take its place as a well recognized surgical procedure in certain eases where delivery is impossible by natural means.
In brief, the operation is performed by making a vertical incision six or seven inches long in the mid-line of the abdomep over the pregnant uterus. When the uterus is exposed it is drawn into the wound, incised from above downward, and the child and placenta rapidly removed. After this the incision in the uterus is carefully closed by sutures, and it is allowed to fall back into its place. The abdominal wall is then brought together after the usual methods of suture and a suitable dressing applied. A very small death-rate attends the operation as at present practiced.
A modification of the Caesarean operation, known as Porro's operation, removes the uterus after it is freed of its contents, thus obviating any possibility of a future pregnancy. Consult Kelly, Operative Gyntreo/ogy (New York, 1S9S).