* Caecsarean Section means incision of the uterus through the abdominal walls and extrication of the fœtus therefrom. Operation like this upon a dead subject requires no skill of a surgeon. Any one can do it without the help of any anatomical knowledge. In modern times, when the mother's life is in peril, and the expulsion of the fœtus becomes nearly impossible, by the natural passage, owing to an existence of deformity either in the parturient canal or in the forms and structures of the fœtus to save both mother and child this operation is principally undertaken.
The evidence of similar attempts, in ancient India, is found recorded in passages like what we have just translated and that the operation was practised on living subjects, there is not the least doubt about it. This custom is still preserved in Central Africa, and it is possible that the Egyptians like Hindu philosophy and religion learnt this also from the Hindus. "Felkin," says "Baas in his History of Medicine p. 70 "saw a case of the Caesarean operation in Central Africa performed by a man. At one stroke an incision was made through both the abdominal walls and the uterus. The opening in the latter organ was then enlarged, the haemorrhage checked by the actual cautery, and the child removed. While an assistant compressed the abdomen, the operator then removed the placenta. The bleeding from the abdominal walls was then checked. No sutures were placed on the walls of the uterus but the abdominal parietes were fastened together by seven figure-of-eight sutures, formed with polished iron needles an 1 threads of bark. The wound was then dressed with a paste prepared from various roots, the woman placed quietly upon her abdomen, in order to favour perfect drainage, and the task of the African Spencer Wells was finished. It appears that the patient was first rendered half unconscious with banana wine. One hour after the operation the patient was doing well. And her temperature never rose above 101 F. nor her pulse above 108. On the eleventh day the wound was completely healed, and the woman apparently as well as usual."
The bladder is ruptured, the dead child lies like a weight upon the placenta and is pressed upward on the spleen, liver and gall bladder. The mother shivers and is oppressed with tremor, dryness of the tongue, dyspnoea and perspiration. She complains of a cadaverous smell in her breath and stands in danger of imminent death. By these symptoms a physician shall know the death of the child in the womb. This portion is partly recognised by Brahmadeva and is totally rejected by Jejjadáchárya as spurious.
When we read this evidence of Felkin, we are reminded of the operative steps as described in our own ancient book of Surgery from which modern surgeons have been able to borrow the operation of rhinoplasty. It is a great pity that while in Africa the same practice is still retained intact, we in India by spurious attempts and disgraceful contortions, substitutions of false readings and dismal knowledge of grammar and rhetoric try to prove in the face of strong evidence that in ancient India Caesarean Section was attempted only on cases where one "might not perspire."
If we take in the sense of "a woman whose life is in great danger" and not exactly in the sense of "a woman who is dead" as recommended by Dalian and Arundutta (and which might have been the meaning if instead ofa word likehad been used in the text), we find at once that Weber's remark in his History of Indian Literature p. 270 "that in Surgery they (the Hindus) attained to high proficiency" is not based on the solitary evidence of rhinoplasty alone.
In performing obstetric operations with success examples like this are not rare. If the two different readings andbe taken conjointly into consideration we are impressed with the idea that in ancient India Cesarean operations were very frequently undertaken in cases of puerperal eclampsia, where the mother had been in the deplorable condition of a goat suffering from cramps and convulsions as well as in cases of an accidental death nut unlike that which fell to the lot of the poor mother of him in whose name the operation is called.=goat= destroyer (See Monier William's Dictionary) hence a goat-destroyer=a tiger or wolf) or in cases where the presence of deformity in the parturient canal or of malformation of the foetus prevented the natural delivery of a living child. The incision is not to be made anywhere else but exactly in the place where Felkin saw the illiterate Negro successfully apply his knife, the selection ofas suggested by some commentators being a tempest on a tea pot especially when the subject is beyond the grave. In a living subject the selection of a proper site for the operation is of course very commendable. Hence we venture to suggest that extraction of the living fetus from the womb by making incision through this part of the pelvis was also attempted later on. We extract here the two different readings and leave our readers to judge whether we are correct to draw the above inferences. - Ed.
Bagabhata S'árira S'.hanam. ch. II. slo. 53.
Thus ends the eighth Chapter of the Nidâna Sthânam in the Sus'ruta Samhitá, which treats of Nidânam of difficult labour and false presentations.