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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    backwards in order to accomplish it. This aperture was found much more altered than the outlet; one finger only edgeways could be placed between the points of bone in the conjugate diameter. In^traversing it from side to side I could detect no great difference, but if there was any, the left was the most contracted. In the transverse diameter I could just place three fingers parallel to each other. The figure of the brim was tripartite, having a slit on each side ; and a third passing forwards produced by the approxi¬ mation and jutting out of the pubes, which was so narrow that the finger could not pass within it. This alteration in the brim was occasioned by the falling downwards and forwards of the upper part of the sacrum, and the lower lumbar vertebra, and by the body of the ossa pubis and ischia being forced backwards and in¬ wards, whilst the symphysis and rami of the pubes projected for¬ wards and upwards. The measurement of the conjugate diameter did not exceed three-quarters of an inch, or that of the transverse two inches ; and having placed my fingers upon each other in the widest part, and having measured them when withdrawn, I con¬ cluded that no body of a diameter greater than from three-quar¬ ters to one inch could pass through it; and that delivery per vias naturales, aided by the crotchet, was utterly impracticable. An¬ other important feature in the case was, that no part of the child or os uteri could be felt. Upon these grounds, then, we concluded that our only resource was the Caesarean section. Our opinions were now stated to the husband and friends, and they cheerfully submitted to any prac¬ tice we thought best to adopt. The patient, anxious to have her sufferings terminated, also readily acquiesced in our decision. An enema was ordered to be administered, and it soon ope¬ rated. The catheter was also introduced, but little urine was withdrawn. As the patient felt cold, a little warm wine and water was given, which acted beneficially. Having placed her upon a table, an incision of six inches long was made through the abdominal integuments about one inch to the left of the umbili¬ cus, extending from three inches above to three below. A small opening was made into the peritoneum, and this membrane was afterwards fully divided by a probe-pointed bistoury. The ute¬ rus was now exposed, and an excision of equal length was made in¬ to this organ, nearly dividing its entire substance. An opening was now made at the lowest point of the wound by the knife, so as to admit the finger, upon which the bistoury was again passed, and the uterus was laid open. I now passed my hand,' and, taking- hold of the thigh of the child, readily extracted it; but unfortu¬ nately it was dead. The funis having been divided, the placental portion was held firmly in the left hand, whilst the right was in¬ troduced into the uterus to extract the placenta, which was attach¬ ed to the upper and posterior part of the uterus. As soon as the