How Janet Hyslop, a woman doomed to die on the day she became pregnant, helped pioneering surgeon Charles Bell find a safer way to perform caesarean sections – Susan Morrison

After Charles Bell reasoned that caesareans could be carried out with small incisions, newspapers began reporting cases where women had survived

On a freezing day in January 1800, Janet Hyslop, an ordinary woman from Penicuik, was about to have a baby. In the room with her were three medical men. Her good local doctor, Mr Renton, and the brothers Bell – Charles and John – the sort of 19th-century pioneering surgeons who had honours heaped on them, medals thrown at them, and most flattering to the 19th-century medical man, syndromes named after them. Charles Bell detailed the failure of the facial nerves which leads to Bell’s Palsy. John held mesmerising lectures at Edinburgh University teaching generations of rising surgeons.

Janet was being readied for the birth. The only way to deliver her baby was by caesarean. Everyone in that room knew it was going to kill her. This wasn’t Janet’s first difficult labour. According to Charles in his description of the delivery, her attending doctor, Mr Renton, surgeon of Penicuik “had, in a manner deserving the highest praise, delivered the woman on former occasions with the crotchet”. The crochet in question was a large curl of metal used to either re-position the head of the baby, or to drag the dead child out. This, remember, before gas and air.

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Janet must have known that this delivery would be fatal. She suffered from a condition known as puerperal osteomalacia. It's caused by a vitamin D deficiency in adults. It ‘softens’ the bones. They curl in towards each other, and crucially, this narrowed her pelvis so much that a normal delivery was completely out of the question.

The Bells were probably the safest pair of hands Janet could have found herself in, since both men were known for their kindness to their patients. John in particular started feuds with surgeons he regarded as needlessly reckless and caused more pain to their patients. Given the standards of surgery at the time, just how you could make 19th-century surgery more painful is a moot point.

The doctors did what they could, but Charles wrote that he “already despaired of the woman's recovery” when they started to go in. His brother John cut clean down the abdomen, Charles pulled the skin apart, opening the uterus, and Mr Renton stepped smartly forward to lift the child free.

Charles immediately dressed the massive wound, put stitches in and strapped up the damage, but the surgery had cut through huge veins and arteries. All they could do was literally hold Janet together for 20 minutes whilst she held her son, then died. He was named Caesar, as most children born by surgery at this time were.

Janet was laid to rest a few days later in February 1800. And then her peculiar afterlife began. Three weeks after her death, Charles Bell had her exhumed and took delivery of her body for dissection. Incredibly, despite the passage of time, the autopsy was a revelation to Charles. Despite the fact that Janet had been dead for nearly a month, he was still able to see that the catastrophic damage from the surgery itself led to irretrievable haemorrhaging.

Caesareans are now commonplace, but once they were a death sentence for the mother (Picture: Brendan Hoffman/Getty Images)Caesareans are now commonplace, but once they were a death sentence for the mother (Picture: Brendan Hoffman/Getty Images)
Caesareans are now commonplace, but once they were a death sentence for the mother (Picture: Brendan Hoffman/Getty Images)

Surgeons at that time slashed their way in to get the baby out. Caesareans were not there to save the mother’s life, far from it. The situation was pretty hopeless before the surgeons got to work. Charles reasoned that caesareans could be carried out in a different way. Instead of the gungho slash-and-dash, he proposed a single small incision, away from the blood vessels. A finger could be introduced “another finger might be passed, and then a third, and at length the whole hand, in a conical form”. The baby could be lifted clear, the umbilical cord cut, the placenta safely expelled and there was a fighting chance for the mother.

And there must have been. Surviving mothers and children are newsworthy. Newspapers from places as far afield as Bradford and London start to report both mothers and babies surviving caesareans, and several mention “small incisions” used in the procedure.

In 1826, a Scottish surgeon trained at the University of Edinburgh only nine years after Janet’s death, performed the first caesarean in Cape Town where the mother and baby survived. Although the medic was primarily a military surgeon, the list of classes taken on the doctor's graduation confirms attendance at anatomy and midwifery lectures, all of which must have helped Dr James Barry carry out this tricky procedure.

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We now know that Dr Barry was actually Margaret Anne Buckley, the woman who chose to live as a man until the very end. A charwoman called Sophie Bishop, paid to wash and lay the body out, blew the whistle. Janet Hyslop unwittingly helped to save the lives of incalculable numbers of women, and their babies.

Today the western world pretty much takes the c-section as fairly run-of-the-mill. It’s mildly discouraged, but there's no denying it’s a safe, reliable way of delivering a baby, and that is partly due to a woman who died 223 years ago. Janet’s skeleton is on display today at the Surgeons' Hall Museum in Edinburgh. They take very good care of it. It is intensely moving to stand in her presence.

Those bones tell an awful story, of a woman so deprived of nutrition that her bones were collapsing, a woman who had no choice but to have another child, and a woman who must have known on the day she found out she was pregnant that she was going to die.

She is deserving of a place in our hearts, but it’s worth remembering that she didn’t ask to be put in a glass case and gawped at. We can create the most amazing 3D imaging today, so could we perhaps scan Janet’s bones and then respectfully lay her to rest, with our thanks?

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