[115] The late Professor Young, of Edinburg, has described a case of this sort in his lectures: he distinctly “heard the head crack, and a large quantity of fluid came away.”
[116] Observationes Anatomicæ, 52. A similar case has been recorded by Dr. Wrangel, in the Archiv. der Gesellschaft der Correspondirenden Aerzte zu St. Petersburg.
When called to the case, the forceps had been already applied by a colleague, but could not be locked, owing to the enormous tumour of the head. A doughty swelling was felt between the blades of the forceps, of such a size that he could only just reach the cranial bones. He made pretty strong traction twice, when unluckily the instrument slipped off; it seemed, however, to have brought the head so much lower, that the child was delivered in ten minutes afterwards by the natural efforts: it was dead. A sac filled with serous fluid, and as large as the head itself, was attached to the occiput; it was covered by the cranial integuments, and in ten hours afterwards, as the fluid had found its way through the open sutures into the cranial cavity, the tumour had the appearance of a hydrocephalus.
[117] Quoted by Dr. Lee in the Med. Gazette, Dec. 25, 1830, from the Journ. Gén. de Méd. tom. xliii. xlv.
[118] Merriman’s Synopsis, p. 216.; also Dr. J. Y. Simpson’s fifth case of fatal peritonitis, in Edin. Med. and Surg. Journ. No. cxxxvii. The patient had suffered under four different attacks of venereal disease. Some interesting cases have been published in the Neue Zeitschrift für Geburtskunde, band vii. heft 1. by Dr. Bunsen of Frankfort and Dr. Kyll of Cologne. In almost every case of great accumulation of liquor amnii, the child was dead, hydrocephalic, or with ascites and in many the placenta was diseased.
[119] [Dr. Churchill has given a table of the length of the umbilical cord in 500 cases. In 127 of these, the cord was 18 inches long, in 77 cases 24 inches, and in 45 cases 20 inches long. The extremes were 12 and 54 inches. Op. Cit.—Ed.]
[120] In a case of this sort Mauriceau says, “Ce nœud étoit extrémement serré: mais cela ne s’etoit fait seulement que dans la sortie de l’enfant; car s’il eût été long-temps serré de la sorte dans le ventre de la mère, l’enfant auroit certainement peri; à cause que le mouvement du sang que lui étoit nécessaire, auroit été entièrement intercepté dans ce cordon. J’ai encore accouché depuis ce temps la, sept autres femmes, dont les enfans qui étoient tous vivans, avoient pareillement le cordon noüé d’un semblable nœud qui s’étoit fait de la même manière, par l’extraordinaire longueur de leur cordon.” (Obs. 133.)
[121] [Dr. Zollickoffer, of Middleburg, Md., relates two cases, in each of which there was a knot upon the cord without any injury to the children. American Journal, Med. Sc. July 1841, p. 109.—Ed.]
[122] Van Swieten, in his Commentaries on Boerhaave, gives a remarkable instance of its occurring twice in the same patient, so as to destroy the child. “I had occasion to see two instances of the birth of a dead child in one lady of distinction, where every thing was exactly and rightly formed; only the navel string was, towards the middle, twisted into a firm knot, so that all communication between the mother and fœtus had been intercepted. The umbilical rope seems to have formed by chance a link, through which the whole body of the fœtus passed, and afterwards, by its motion and weight, had drawn the knot, already formed, into such a degree of tightness, that the umbilical vessels were entirely compressed; for when the knot was loosened out, all that part of the navel string which was taken into the knot was quite flattened.” (Vol. xiii. § 1306.)
[123] One of the most remarkable cases of extreme pelvic deformity from mollities ossium is described by Professor Naegelé in his Erfahrungen und Abhandlungen. The patient was the mother of six living children when she was attacked with the disease: the seventh, after great difficulty, was born dead, and the eighth was delivered by the Cæsarean operation, which proved fatal. The spine was pressed so downwards, that the third lumbar vertebra was opposite to the superior edge of the symphysis pubis; the distance of the left ramus of the pubes from the fourth lumbar vertebra was only 2½ lines; the transverse diameter of the inferior aperture only 1 inch 9 lines. For the farther details of this interesting case we may refer to our published lectures on this subject. A similar and highly interesting case has been recorded by Mr. Cooper, and communicated by Dr. Hunter in the Medical Observations and Inquiries, vol. v. The patient’s first three labours were rather easy; in the beginning of her fourth pregnancy she had a violent rheumatic fever, which continued about six weeks; from this time she never enjoyed good health and suffered constantly from rheumatic pains over her whole body: these were followed by laborious respiration, and gradual distortion of spine: her fourth labour was accomplished with much difficulty. During her fifth pregnancy the distortion continued to increase. In her sixth and seventh labours the pelvis was found much contracted, so much so in the last as to require perforation. In her eighth labour the pelvis then appeared to be somewhat less than 2½ inches from the symphysis of the ossa pubis to the superior and projecting part of the os sacrum, and otherwise badly formed. Embryotomy was again performed. She had become much more deformed and helpless, but in three years afterwards she was again pregnant. “She now appeared to be little more than an unwieldy lump of living flesh.” The antero-posterior diameter was now only 1¼ inch, becoming gradually narrower at each side. The Cæsarean operation was performed with a fatal result. On examination after death, the rami of the ischium were found “little more than half an inch asunder.”