We have already stated the doubtful utility of arranging cases of deformed
pelvis according to their degree of contraction, and of classifying the
different modes of treatment by such a scale; still, however, there must
be certain limits beyond which it will be impossible to make the child
pass, even when diminished by embryotomy. To draw the precise line of
demarcation, however, will be nearly if not quite impossible; and, as in
cases of slighter deformity, we must take many other circumstances into
consideration which we have already mentioned. An inch and a half from
pubes to sacrum has been mentioned by many as the extreme degree of
contraction through which a full grown child can be delivered by
embryulcia; generally, however, in these cases of unusually deformed
pelvis, there is much more space on each of the sacrum; and on this, in
great measure, will depend the possibility of effecting the delivery. The
celebrated case of Elizabeth Sherwood, which Dr. Osborn has recorded, and
where he succeeded in delivering the child, although the antero-posterior
diameter "could not exceed three-quarters of an inch," has been looked
upon as being of doubtful accuracy, and that Dr. Osborn had
unintentionally deceived himself. When, however, we learn that on the
right side of the sacrum the antero-posterior diameter was an inch and
three-quarters, the incredible nature of the case diminishes considerably,
the more as the patient was examined by Dr. Denman and others who fully
coincided with Dr. Osborn's statements. To assert that in this case the
antero-posterior diameter was only three-quarters of an inch, as many have
done, is evidently incorrect, and tends to throw doubt upon it: the case
was evidently the closest possible approach to the limits requiring the
Cæsarean operation; its success was mainly attributable to the gradual
manner in which it was performed; the child had become completely soft and
flaccid from putrefaction, and was thus more capable of being moulded to
the contracted passage.
CHAPTER V.
FIRST SPECIES OF DYSTOCIA.
_Obstructed Labour from a Faulty Condition of the soft Passages._
_Pendulous abdomen.--Rigidity of the os uteri.--Belladonna.--Edges of
the os uteri adherent.--Cicatrices and collosities.--Agglutination of
the os uteri.--Contracted vagina.--Rigidity from age.--Cicatrices in
the vagina.--Hymen.--Fibrous bands.--Perineum.--Varicose and
oedematous swellings of the labia and nymphæ.--Tumours.--Distended or
prolapsed bladder.--Stone in the bladder._
In speaking of the uterus itself as a cause of this species of dystocia,
we only mention it here as one of the soft passages, not as the organ by
the contractions of which the child is expelled; we merely refer to those
faulty conditions of the uterus which produce an impediment to the child's
progress, not to those which interfere with the natural condition of its
expelling powers, as this will be considered under the next division of
dystocia.
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