Case of delivery, without operative aid, through a pelvis extremely deformed by malacosteon / by J.Y. Simpson.

  • James Young Simpson
Date:
1847
Catalogue details

Licence: Public Domain Mark

Credit: Case of delivery, without operative aid, through a pelvis extremely deformed by malacosteon / by J.Y. Simpson. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    14/24 page 12
    On examining into the condition of the pelvis, Mr Wiseman at once found that its outlet was extremely contracted, but the preg- nancy was already so far advanced as to preclude, under such a degree of deformity, the idea of delivery by the induction of abortion or premature labour. Besides, all attempts to touch the OS uteri proved ineffectual, so that none of the ordinary means of arresting pregnancy, and exciting uterine action, could have been put into practice. Early in March I visited Mrs D. along with Mr Wiseman, Dr Graham, and Dr Grace. She was quite incapable of moving or turning in bed without assistance. The uterine tumour was high, and pressed over to the right side. On applying my stethe- scope to it, I readily detected the usual rapid pulsations of the fo3tal heart. I found fully borne out the correct description which had been previously given me of the excessive deformity and con- traction of the pelvis. The sacrum was straight above, so that its promontory did not probably encroach on the brim; but its inferior extremity was strongly and anormally curved forwards. In front the walls of the pelvis felt doubled or collapsed together; and the outlet, which was the only part that could be very accurately examined, was exceedingly deformed and diminished in size. The transverse diameter was particularly contracted. I found it impossible to introduce two fingers between the tuberosities of the ischia. Hence this diameter of the outlet was evidently under an inch. Posteriorly, or opposite the sacro-sciatic ligaments, there was transversely more space, but the strong anterior curvature of the coccyx and lower end of the sacrum seemed to curtail the conjugate diameter of the opening, and to prevent the probability of it admitting, when fully dilated, more than three, or, at most, four fingers even in this direction. Under these circumstances, with a living child advanced to the eighth month, and a pelvic outlet so extremely contracted, I had no hesitation in coming to the same conclusion as the patient's medical advisers had all previously done,—namely, that the Ca^sarean section was the only practicable mode of delivery. I was aware that Barlow, Conradi, Sprengel and others had seen and published cases of moUities ossium, in which the softened and still flexible pelvic bones had bent and yielded during labour so as to permit the passage of the child without operative interference; but in Mrs D. the osseous tissue appeared far too firm to permit us to indulge even in this faint hope. Nature, however, provided, and was perhaps already preparing for the mother, a mode of delivery that was still more safe and easy. Ilavin agreed to operate in case the Cesarean section Avas required,*^! anxiously waited in the daily expectation of being called to Mrs D. At last, on the morning of the 28th April, I received from Mr Wiseman a note, dated the previous night, inti- mating that our patient had begun to complain of labour pains—
    digitised image 1
    digitised image 2
    digitised image 3