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"As a hopeful sign, it is to be noticed that a gradual change is taking place in the opinions of the profession as to the propriety of performing craniotomy.
Second, that the mother has a reasonable prospect of being saved. "Late reports of the Dublin Rotunda Hospital show that, in 3,631 cases of labor, craniotomy was performed only four times, and in three of these, positive diagnosis of the child's death was ascertained before the operation. In one of these cases the diagnosis was doubtful.
Irwin reports a case in which the firm attachment of the fetal head to the uterine parietes rendered delivery without artificial aid impossible, and it was necessary to perform craniotomy. The right temporal region of the child adhered to the internal surface of the neck of the uterus, being connected by membranes. The woman was forty-four years old, and the child was her fourth.
Chevers speaks of a mother at ten and others at eleven and twelve; and Green, at Dacca, performed craniotomy upon the fetus of a girl of twelve. Wilson gives an account of a girl thirteen years old, who gave birth to a full-grown female child after three hours' labor. She made a speedy convalescence, but the child died four weeks afterward from bad nursing.
In Belgium the Cesarean section has been performed seven times on the same woman, and in Philadelphia three times. Doctor Bretoneaux, of Tours, has performed it six times on the same woman; and this woman his wife. 'The brutal epoch of craniotomy has certainly passed.
So, we see, the principal points of the opinion enunciated by the learned judge, and the principles therein laid down, can, with equal force, be applied to the non-justification of craniotomy, by which the life of a defenceless child is sacrificed to save the mother.
"Caruso, therefore, concludes that craniotomy on the living child is to be superseded by Cesarean section. He says, therefore, that the mother has three chances out of four, and her child nine out of ten, for life. "Leopold, as stated above, shows a much better result, viz.: ninety-five mothers saved out of one hundred by Cesarean section, a result equal that obtained in craniotomy."
Dickinson describes a woman, a tertipara, who had a most difficult labor and bore an extremely large child. She had been thirty-six hours in parturition, and by evisceration and craniotomy was delivered of a child weighing 16 pounds. Her first child weighed 9 pounds, her second 20, and her third, the one described, cost her her life soon after delivery.
This in fact is the contention of the defendant of craniotomy to whom I have referred; and he boldly applies his speculation to a matter in which the physician has the most frequent opportunity to exhibit his fidelity to principle, or his subserviency to the requirements of temporary expediency at the sacrifice of duty.
Gentlemen, so far I have explained the duties which the physician has in common with all other men, and which arise directly from the natural law independently of any civil legislation. The natural law requires the Doctor to respect the life of the unborn child, thus forbidding craniotomy and abortion. It also obliges him to protect his patients from the baneful effects of venereal excesses.
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