Two cases of impracticable labour arising from malacosteon of the pelvis, in which the caesarean operation was performed; accompanied with practical observations / [Thomas Radford].

  • Radford, Thomas, 1793-1881.
Date:
[1841]
Catalogue details

Licence: Public Domain Mark

Credit: Two cases of impracticable labour arising from malacosteon of the pelvis, in which the caesarean operation was performed; accompanied with practical observations / [Thomas Radford]. Source: Wellcome Collection.

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    I was informed bv Mr Morris that she had been in strong la- bour about thirty-four hours ; that the membranes had ruptured in two hours after its commencement; and that the liquor arrinii had gradually passed away. He had not been able to feel the presentation nor the os uteri. The pains were strong for twenty- four hours, but afterwards gradually abated. The urine had been passed freely during the Saturday; but this day (Sunday) there was no evidence of any having been discharged. The bowels were constipated, and had not been opened during the labour. Her previous history was to the following effect. She had borne ten children, nine of whom were expelled by the natural powers. In the last labour considerable difficulty occurred, and the practitioner had recourse to craniotomy. During her tenth pregnancy she experienced considerable weakness in her loins, and felt rheumatic pains about the hips, and limped in her gait. These pains continued from that time till her present pregnancy, but did not increase in degree. When she became again preg¬ nant her sufferings increased, and her lameness became more ma¬ nifest. Her stature was now observed to diminish in height. She was 42 years of age, and was employed as a hat-trimmer. I found her in bed lying upon the back, with the head and should¬ ers raised. She moved writh the greatest difficulty. The pulse was feeble and frequent, beating about 150 in the minute. She had often vomited, and had great tenderness in the belly, which was con¬ siderably increased by pressure. Her tongue was furred and dry, and she complained of great thirst; her countenance expressed considerable anguish. Being requested to compose her mind, she answered, “ she was composed, but anxious for relief, and would suffer any pain so that she might be delivered.” Upon examining the abdomen, I found the uterus projecting very much forwards, and lying with its anterior surface upon the upper part of the thighs. By a vaginal examination I discovered that the labia were much swelled, and the vagina felt dry and rough ; it was hotter than natural; and an odour similar to that arising from animal matter when partially decomposed was per¬ ceived from the hand when it was withdrawn. The outlet of the pelvis had undergone great change ; the arch of the pubes was to¬ tally destroyed by the near approximation of the rami of the ischia and pubes, having only a small slit, so narrow at the upper and lower parts as not to admit the point of the index finger ; at the middle, however, the finger could just be introduced. The tubero¬ sities of the ischia were not more than one inch and a-half to one inch and thtee-quarters asunder ; and the lower portion of the sa¬ crum was so much more incurvated than natural, as to throw the coccyx much more forward, and consequently lessen the conjugate diameter of the lower aperture of the pelvis. This great diminution in the outlet rendered it difficult to pass the hand in order to measure the brim, and it was found necessary to carry it very far