Selected obstetrical and gynecological works / or Sir James Simpson ; containing the substance of his lectures on midwifery ; edited by J. Watt Black.

James Young Simpson

Date:: 1871

Credit: Selected obstetrical and gynecological works / or Sir James Simpson ; containing the substance of his lectures on midwifery ; edited by J. Watt Black. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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$putrefied infant, after being thus reduced to this diffluent and com- pressible mass, and now capable of being moulded to the contracted apertures of the pelvis, was ultimately and without difficulty expelled through them by the supervention 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, Ave 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 m fact imitations of processes 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 contraction 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 wedge-like pressure of the infant's head ; or the uterus has been lacerated, or, as has hap- pened now in two recorded cases, both the uterus and abdominal parietes have simultaneously ruptured and allowed the escape of the child through this double opening ; or the bones of the child's cranium have become deeply compressed and fractured, so as at last to allow the reduced head to pass ; or the same has been effected by the infant dying, putrefying, and at last its scalp and sutures in the most putrid and almost dissolved state.—See p. 101 of hii Essays.— But, besides, the brim of the pelvis in Sherwood was in reality not so small as the measurement 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 the space intervening between the line of the conjugate diameter and the right ilium. Here there was an oblong aperture 3 inches long (as measured from the ilium to the symphysis pubis), and If inch broad ; and hence in fact an aperture as great as Drs. Hamilton, Hums, Churchill, Uamsbotham, etc., deem necessary for the performance of embryulcio ; and greater than that through which we pulled Mrs. D.'s child.—See drawing of the brim of Sherwood's pelvis, in Dr. Hull's Defence of the Cesarean Section, pi. v. lig. 1.$