Lectures on the theory and practice of midwifery : delivered in the theatre of St. George's Hospital / by Robert Lee.

  • Robert Lee
Date:
1844
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on the theory and practice of midwifery : delivered in the theatre of St. George's Hospital / by Robert Lee. Source: Wellcome Collection.

Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.

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    of the sacrum, there is little or no distortion of the brim, and by- moving the finger from side to side and backward, it will readily be discovered if the tuberosities of the ischia are at the usual dis- tance from each other, and if the direction of the sacrum and coccyx is altered. Dlsto7'tion of the pelvis from rickets. — The softening of tlie bones of the pelvis from rickets occurs generally before puberty, and in a great proportion of cases the long bones of the extremities are likewise atfected, and sometimes, also, the spine. But the spine is not unfrequently affected both with angular and lateral curvature, from ulceration of the vertebrae and cartilages, where the pelvis remains in the natural state. The changes produced in the pelvis by rickets are numerous, and do not differ essentially from those observed in malacosteon. In this short skeleton [showing a speci- men] the head is remarkably large, the long bones of the extremi- ties are all bent, and the pelvis is precisely in the same condition as the pelvis which you have just seen distorted by mollities ossium. The base of the sacrum is pressed forward, and the front and sides of the pelvis inward and backward, so as to give the brim a trian- gular shape. The tuberosities of the ischia have likewise been pressed into contact, and the arch of the pubes destroyed. There is another form of distortion of the pelvis from rickets seen in other pelves and casts upon the table. The brim in these is of an elliptical shape, and the tuberosities of the ischia, instead of being nearer one another than usual, are separated to a greater distance, and the outlet of the pelvis appears enlarged. The sacrum, in most of these, is nearly straight from the base to the apex. In several, the distortion is greater on one side than the other. In all, the distortion has reached a certain point, and then appears to have ceased to increase ; unlike what happens when the pelvis is aflected with malacosteon. The regular process of delivery is necessarily interrupted by all these morbid states of the pelvis. When the distortion of the brim is slight, the head is usually forced through after a protracted labour, and the child is often injured from the pressure it has sus- tained. When the distortion is greater, the head becomes arrested in the brim, and cannot pass till its volume is reduced ; and where the distortion is in a still higher degree, the head of the child never enters the brim, however long the labour may be allowed to continue. If the bones of the extremities are not much bent, and the pel- vis not highly distorted, we are seldom consulted until the full period of pregnancy has been reached, and the person has been long in labour. The delivery may require to be completed with the perforator and crotchet, and the dimensions of the pelvis are then, for the first time, ascertained. In a subsequent pregnancy it becomes necessary to induce premature labour at the end of the seventh, or seventh and a half moiuh — an operation attended with little danger to the mother, and which has preserved the
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