Volume 1

A system of obstetric medicine and surgery : theoretical and clinical for the student and practitioner / by Robert Barnes and Fancourt Barnes.

Date:
1884-1885
Catalogue details

Licence: Public Domain Mark

Credit: A system of obstetric medicine and surgery : theoretical and clinical for the student and practitioner / by Robert Barnes and Fancourt Barnes. Source: Wellcome Collection.

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

    569/624
    Mechanical conditions causing the Death of the Foetus. Torsion, hnotting, or strangulation of the cord.—Many- instances are recorded in which death of the foetus was ap- parently produced in this way. Of the sufficiency of this con- dition there cannot be a doubt. Tying the umbilical cord so as to render the vessels impermeable is equivalent to tying the pulmonary vessels or the trachea of the adult. Asphyxia results. ]Mo3t museums exhibit specimens of twisted and knotted cords. The embryo and fcEtus up to an advanced period of gestation preserve gi'eat mobility in the uterus, especially where the proportion of liquor amnii is large. Severe exertion, the action of the abdominal muscles, as in defecation, may change the position of the foetus. External pressure, as in copulation, may cause the foetus to rotate. But how do we explain knots ? The embryo must pass through a loop of cord, and thus commit suicide. Sometimes it stops short of strangulation. Indeed, complicated knots have been found on the cord, the child being born alive.' It is a familiar fact that the neck of the child may at birth be encircled by one, two, or even three rings of umbi- lical cord. This may be regarded as the first stage of knotting. Ihe foetus does not pass through the loop, it is caught at the neck. In these cases the child does not often perish in utero. The danger comes at the time of labour, when, the head de- scending, the cord is tightened. If this be cut in time the child is saved. The most obvious cause is the undue length of the cord, so that it settles in loops at the lower part of the uterus. Dohrn ^ gives a good account of torsion and the ensuing stenoses of the cord. Euysch and D'Outrepont described them. Meckel ^ affirmed that they are due to revolutions of the foetus, and that they are more frequent in male children. About '75 inches from the umbilicus is the locus minoris resistentioi. Where twistings produce morbid results, Hohl thinks they take place when the head of the foetus rests upon the floor of the ovum; and that strictures rarely occur in mature children. Dohrn narrates a case. A woman conceived in December ; in ' R. U. West, Brit. Med. Jowrn. ^ Monatssehr. f. OehuHsh. 1861. • MiiUcr'g Arcliiv.