The self-performed caesarian

Case of self-performed caesarian sectionA jaw-dropping case was reported in The New York Medical and Physical Journal in 1823, one in which a patient conducted an operation on herself.  The best-known example of self-operation occurred in 1961, when a Soviet surgeon working on an Antarctic base was forced to take out his own infected appendix; this much earlier case took place in more tragic circumstances:

In the afternoon of January 29th, 1822, I was called upon by Jacob Kipp, of the town of Nassau, to consult with Dr. Bassett on the case of his servant girl, who, he said, was in a deplorable situation. I immediately repaired to his house, and found the patient to be a girl fourteen years of age, one-fourth black. She had a firm pulse, and complained of little or no pain. Dr. B. informed me, that she had a wound in her abdomen, near the centre of the epigastric region, from which he had extracted a full-grown foetus, that was in part protruded, together with a considerable portion of her intestines.

On examination I found an irregular incision of about four inches in length, extending in a diagonal direction, as respects the abdomen, about two inches above the umbilicus, and an incision of about two inches in length at nearly a right angle with the former, extending toward the sternum. The lower part of the abdomen was considerably distended with blood.

Our attempts were in the first place directed to the evacuation of the blood contained in the abdomen, which was partly effected by a change of posture and slight compression. We then brought the lips of the wound in contact by the interrupted suture, dressed it with lint spread with emollient unguent, and secured the whole with a broad bandage. After administering an anodyne, we left her for the night. I did not see her again, but was informed by Dr. B. that she never had any very violent symptoms.

The second day he bled her, gave her a cathartic, and pursued the antiphlogistic regimen a few days, when the febrile excitement subsided. An ordinary use of tonics was then resorted to, and in a few weeks the patient was perfectly recovered.

Given the circumstances, it is remarkable that she survived at all.  Dr Francis explains what had happened:

While the family was at dinner, she went a distance of perhaps fifty rods from the house, and placed herself on a snow-drift, near a fence, where she was first discovered by her master in the act of covering something with snow, which afterwards proved to be a naked child. As soon as she perceived that she was observed, she immediately ran to the house, with the second child hanging out at the wound, together with a considerable portion of her intestines; laid by her razor and large needle, which were the instruments she had previously prepared for the operation, and shortly began to complain. I should judge from the appearance of the blood upon the snow, there being three several places where she evidently slopped, that the incision was made immediately prior to the rupture of the membranes, and that the first child was delivered per vias naturales, the third pain after the rupture.

As some of the greatest discoveries in every department of science are made by accident, or without any particular previous design, may not the conduct of this desperate girl give a useful hint for an improvement in the Caesarean operation, consisting in a division of the uterus diagonally, near the fundus, instead of the ordinary method?

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