Caesarean section is now the most commonly performed major operation in many parts of the world. A study published in The Lancet a few months ago estimated that around 30 million caesareans take place worldwide every year; in the UK over a quarter of babies are now born by caesarean, some 175,000 per year.
References to the operation go back centuries, although it is only in the last 200 or so years that medics started to harbour serious ambitions of saving both mother and child. Before then, it was more often an attempt to salvage one life from a situation that was otherwise likely to claim both.
In 1814 the London obstetrician Samuel Merriman published a textbook of childbirth entitled A Synopsis of the Various Kinds of Difficult Parturition. He noted that by then only 22 documented attempts at caesarean delivery had taken place in Britain, and in only one case had the mother survived; eight babies had lived, reflecting the fact that the procedure was usually intended to save the life of the infant rather than that of the mother.
Dr Merriman also alludes to ‘a very astonishing case’, which appears to be the first ‘successful’ caesarean performed in Ireland, performed some 80 years earlier. I use the inverted commas because the only the mother survived. Nevertheless, the circumstances were pretty remarkable. This report appeared in the Medical Essays and Observations in 1742:
Alice O’Neal, aged about thirty-three years, wife to a poor farmer near Charlemont, and mother of several children, in January, 1738–9, took her labour-pains; but could not be delivered of her child by several women who attempted it. She remained in this condition twelve days: the child was judged to be dead after the third day.
Charlemont is a village near Armagh, now in Northern Ireland. In 1738 few women in Alice O’Neal’s situation could have afforded a doctor, or even considered sending for one. In communities such as hers, most would have been attended by local midwives, typically older women whose knowledge was passed down by word of mouth.
Mary Donally, an illiterate woman, but eminent among the common people for extracting dead births, being then called, tried also to deliver her in the common way: and her attempts not succeeding, performed the Caesarean operation, by cutting with a razor, first the containing parts of the abdomen, and then the uterus; at the aperture of which she took out the child and secundines.
‘Secundines’ is an old term for the afterbirth or placenta. You might think this a startling turn of events, and in some ways you’d be right. But many of the earliest caesareans were performed by people who were not medical professionals: one of the first documented cases in which both mother and child survived was an operation performed in 1500 by a Swiss man called Jacob Nufer, described as a sow gelder, on his own wife. In fact it appears that surgeons were generally reluctant to attempt the procedure, appreciating the grievous risks that accompanied it.
She held the lips of the wound together with her hand, till one went a mile and returned with silk and the common needles which tailors use.
The ‘one’ who went a mile to fetch needle and thread was an attendant. This means that the midwife must have been holding the wound closed with her hand for half an hour or more.
With these she joined the lips in the manner of the stitch employed ordinarily for the hare-lip, and dressed the wound with whites of eggs, as she told me some days after, when, led by curiosity, I visited the poor woman who had undergone the operation. The cure was completed with salves of the midwife’s own compounding.
It is easy to be dismissive about the measures taken to dress wounds in the pre-antiseptic era, but some traditional remedies evidently had some antimicrobial effect. We do not know what this midwife used, but whatever it was may have saved her from a life-threatening infection.
In about twenty-seven days, the patient was able to walk a mile on foot, and came to me in a farmer’s house, where she showed me the wound covered with a cicatrice…
Cicatrice = scar tissue.
…but she complained of her belly hanging outwards on the right side, where I observed a tumour as large as a child’s head.
This was a sizeable hernia, a common sequel to caesareans in the pre-anaesthetic era and one that (very rarely) still occurs today.
…and she was distressed with the fluor albus, for which I gave her some medicines, and advised her to drink the decoctions of the vulnerary plants, and to support the side of her belly with a bandage.
Fluor albus (‘white flow’ in Latin), known today as leucorrhoea, is a vaginal discharge, in this case probably caused by a minor infection. Vulnerary plants (from the Latin for wound, vulnus) were those used to treat wounds and inflammation – particularly a number of species known as woundworts.
The patient has enjoyed very good health ever since, manages her family affairs, and has frequently walked to market in this town, which is six miles distance from her own house.
A couple of years later another local doctor, Dr Gabriel King from nearby Armagh, gave an update. He confirmed that he had attended the woman shortly after the operation had taken place, and had removed the needles which the midwife had left in place to secure the wound. He also reported that the woman
…is capable of doing something for her family with the assistance of a large bandage, which keeps in her intestines.
In an age when such a drastic operation was usually fatal for both mother and child, such an outcome was little short of miraculous.