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.

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    emaciated, dead, and highly putrefied infant after being thus re- duced to tills diffluent and compressible mass, and now capable of being moulded to the contracted apertures of the pelvis, is ulti- mately and without difficulty expelled through them by the superven- tion of natural uterine contractions. Each stage and step in this mechanism was necessary for the success of that which followed it, and the imperfection or omission of any one of them, would probably have entirely subverted and prevented the very fortunate and very unlooked for result that occurred from the combination of the whole. 3. Does the mode in which the delivery was effected in this instance by nature suggest any measures of practice which, under similar complications, we could induce and imitate by art ? I put this question, because, in the greater deformities of the pelvis all the standard operations and means which we employ for delivery, are in fact imitations of pi'ocesses and operations which nature herself employs under the same conditions. When the pelvis has been much contracted, abortion has occasionally come on in the earlier months and saved the mother; or premature labour has supervened about the seventh month, and saved both the parent and child. These natural processes we imitate successfully in the artificial induction of abortion and premature labour. If, in morbid con- traction and deformity of the pelvis, the pregnancy goes on to the full time, nature is still sometimes capable of delivering the mother by other and various measures. Occasionally, during labour, the symphysis pubis has been rent asunder under the intense and with common sense ; for how could the hase of the cranium which is 1 h inches in thickness, and nearly three in breadth, be brouglit through the apertui-e which he describes. A fair estimate (Dr Campbell continues) of the utter impossibility of effecting it may be afforded by the simple experiment of form- ing in a plate of hardwood, an opening in shape and size, exactly corresponding to the pelvis of Sherwood, and attempting to force through it the base simply, divested of the other portions of the skull. {Midmfery, pages 317 and 318.) In the case of Mrs D— I obtained the corroborative evidence afforded by the very experiment which Dr Campbell here properly suggests; and I have already stated the facility with which the cliild was passed through tlie perforated plate. In Sherwood's case there was, I believe, the same reason for the practi- cability of delivery, for the foetus seems to have been in the same putrid and decomposed state as Mrs D.'s child, and perhaps the bones of the face and basis of the cranium were in a similar way loosened and compressible. The whole body of the foetus was, to quote Dr Osborne's own words, in the most putrid and almost dissolved state. See p. 101 of his Essays.—Qxit, besides, the brim of the pelvis in Sherwood was in reality not so small as the measure- ment of its conjugate diameter would seem to indicate. During delivery the OS uteri was pulled by Dr Osborne over to the right side, or to space intervening between the line of the conjugate diameter and the right ilium. Here there was an oblong a])erture 3 inches long (as measured from the ilium to the sympliysis pubis), and 1 ij inclies broad ; and hence in fact an aperture as great as Drs Hamilton, Burns, Churchill, Ramsbotham, &c., deem necessary for the performance of cmbryulsio; and greater than tbat through which we iniUcd Mrs D.'s child.—See drawing of tlie brini of Sherwood's pelvis, in Dr Hull s Defence of the Vitsarcan Section, V\. v. fig. 1.