A practical treatise on midwifery / translated by T. F. Betton and edited by P. B. Goddard.

  • François-Joseph Moreau
Date:
1844
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Licence: Public Domain Mark

Credit: A practical treatise on midwifery / translated by T. F. Betton and edited by P. B. Goddard. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    the dilatation of a narrow thorax, of which the ribs, closely approximated, were almost immovable. Her respiration became difficult, and a bluish, livid colour, proved that the function of hematosis was performed with difficulty, or not at all; so that she could not preserve a horizontal position for more than a few minutes, without being threatened with suffocation. The pelvis, contracted in its cavity, and especially in the inferior strait, could not afford a passage for the child. The sacrum and pubes formed two planes inverted in contrary directions, very much separated above and approximated below, between which the head of the foetus became impacted as it advanced. In this distressing condition the section of the symphysis pubis, or the Caesarian operation, was indicated as the only chance for the life of the mother and child. But her difficulty of respiration was so great, and the danger of suffocation so imminent when she attempted to lay down, that after several consultations and long discussions during the day and part of the night, this idea was abandoned from the fear of the death of the patient before the termination of either operation. It was then determined unanimously to endeavour to accomplish the delivery per vias naturales. Desormeaux tried in vain several times to advance the head by means of the lever: this was abandoned and craniotomy resorted to and performed in the erect posture, which the patient had been obliged to maintain for more than three months. This young lady, notwithstanding the best treatment and most assiduous care, survived but a few days. Her pelvis, remarkable for its defective inclination—the flattening of the sacrum, the inclination inward of the inferior part of the pubes, and the narrowness and faulty direction of the inferior strait—was preserved by Desormeaux, and exhibited by him annually to his pupils in his admirable course of lectures. The following are the dimensions of this pelvis, which has been presented to me by the family of M. Desormeaux. SUPERIOR STRAIT. Antero-posterior diameter, Transverse “ Oblique “ inches, lines. 5 2 5 2 4 6 CAVITY. inches, lines. INFERIOR STRAIT. inches, lines. Antero-posterior diameter, 3 6 Antero-posterior diameter, 2 6 Transverse “ 4 8 Transverse “ 3 8 Oblique “ 4 2 Oblique “ 3 2 In a case of Caesarian operation performed on the 4th of February, 1833,* a case which it is to be regretted leaves so much unexplained:—1st, as regards the motives which induced the operation rather than some other resource, as the woman had been pregnant seven times previously, had in these pregnancies aborted twice, and been safely delivered five times per vias naturales by the forceps, of four still-born children and one which lived eighteen months: 2d, concerning the circumstances accompanying the operation, and which would have been important, inasmuch as the incision was made in the posterior and not the anterior paries of the abdomen: 3d, those which preceded the death of the woman, who survived only fifteen hours; its author, M. Bello, has pointed out in the inclination of the pelvis a deformity which is in some manner a counter-part of that which we have just described. In the case of M. Bello, the pelvis was united to the spinal column at a right angle, so that in the sitting posture the woman rested on the posterior surface of the sacrum instead of the tuberosities of the ischia, the latter being directed forward and slightly downward. The distance between the extremities of the false ribs and the anterior superior spinous of the ilia was only nine lines. The lumbar column, composed of four vertebral bodies and five spinous processes, and two and a quarter inches distant from the symphysis pubis, divided the superior strait into two unequal portions, of which the right was the larger. The antero-posterior diameter of the superior strait was four inches eight lines; the transverse, four inches nine lines; the oblique, four inches four lines: of the inferior strait, the antero-posterior was four inches two lines; the transverse, two inches nine lines. In other cases the pelvis inclines forward scarcely at all, so that the axis of the superior strait becomes nearly that of the body of the woman, resulting generally from the elevation of the pubes, or the depression of the sacrum—a disposition which must necessarily diminish the antero-posterior diameter of the superior strait. Under these circumstances, the child’s head, instead of following the axis of the superior strait, rests sometimes on the upper part of the pubes, from which it is difficult to dislodge it. The foregoing are the principal deformities of the pelvis. As has already been remarked at p. 25, they rarely exist alone ; they are combined and associated together sometimes without any order, but most frequently with a species of regularity, constancy, and harmony, which enables us, one being known, to judge of the resistance of the other. ARTICLE IV.—GENERAL CAUSES OF DEFORMITIES OF THE PELVIS. If we examine the general causes of deformities of the pelvis, we shall find that they may be produced by all those which occasion any modification or change in the vitality and nutrition of the bones, at whatever period of life they may occur. The most frequent of these causes is undoubtedly rachitis. When it appears in early life, it arrests the development of the bones, and prevents them from acquiring solidity sufficient to resist efficiently the various compression they must undergo. The skeleton is singularly altered and modified in shape; the bones of the limbs become swollen and tumefied at their articular extremities, and, in common parlance, the child is said to grow rickety. The bones curve unnaturally, twist in various directions; the pelvis, upon which is exerted the double pressure spoken of previously, becomes deformed in proportion to the intensity and duration of the disease. An examination of the pelves of rachitic women will prove the bones to be lighter, thinner, and smaller, than those of other females: the same is true with regard to the bones of the limbs, cranium, and face. Even the teeth, which compose no part of the osseous system, are often marked by the disease. But when this affection first manifests itself about the approach of puberty, and a fortiori at a still more advanced period of life, the alteration is less extensive, less serious, and the deformities less numerous; they chiefly are seen in the bones of the thorax and of the spinal column, which is more or less curved; the bones and cavity of the pelvis, having * Transactions Medicates, cahier de Septembre 1833, tome xiii., page 285. <