[124] [A second case has been recorded by Dr. Schultzen, see American Jour. Med. Sc. July 1841, p. 238.—Ed.]
[125] “Mechanical obstruction to the progress of labour, is sometimes produced by thus fatiguing the woman with continual walking. I have known the whole of the cellular substance lining the pelvis so much distended by œdematous tumefaction, as to make the pelvis greatly narrowed in its capacity, which repose for some hours has diminished, or entirely removed.” (Merriman’s Synopsis, p. 18. last edit.)
[126] Mr. Barlow has attempted to form a synoptical table of pelvic distortion. Thus, he says, where the antero-posterior diameter of the brim is from 5 to 4 inches, delivery can be effected by the efforts of nature alone; where from 4 to 3 or 2¾ inches, delivery may take place by the efforts of nature, or assisted by the crotchet, or lever; from 2¾ to 2½ inches, it requires artificial premature delivery; from 2½ to 1½ inches, embryulcia; and from 1½ inch to the lowest possible degree of distortion, the Cæsarean operation.
[127] For many of the above observations we are indebted to an admirable article upon the subject by our friend, Professor Naegelé, jun., in the Medicenischen Annalen, band ii. heft 2.
[128] Dr. Merriman has detailed two interesting cases, which were terminated by the natural powers. In the first (p. 59,) the patient died afterwards, a small laceration having taken place in the vagina; the other appears to have arisen from an unruptured state of the hymen, which was of unusual thickness; (see Appendix II.) The case did well.
[129] For much valuable information on this subject, as also for several interesting cases, we gladly refer to Facts and Cases in Obstetric Medicine, by our friend Mr. Ingleby, of Birmingham; a practical work of great value.
[130] [The following very singular case of tumour of the pelvis is recorded by Professor D’Outrepont, of Würtzburg.
A woman, twenty-six years old and well made, gave birth when twenty-five years of age to her first child without difficulty. Towards the end of her second pregnancy she again applied at the hospital in consequence of experiencing pain in the pelvic region. Vaginal examination discovered a hard and painful tumour, extending from the inner surface of the left ischium nearly to the corresponding point on the opposite side. It was hard, globular, even on its surface, and occupied the ascending ramus of the ischium and the descending ramus of the pubis, and extended over the obturator foramen. It was impossible to reach the lower segment of the uterus, or to feel any part of the child.
The size and hardness of the tumour seemed to leave no chance of the birth of a living child, even by the induction of premature labour. Professor D’Outrepont, who doubted whether the tumour was fibro-cartilaginous, or a true bony exostosis, asked the opinion of many eminent men who saw the case. They did not express themselves with certainty as to its nature, and the patient refused to allow an experimental incision to be made into the tumour.
A short time before labour began, the tumour was thought to have become slightly compressible. When labour commenced, the professor called a consultation in which it was determined that unless a great change had taken place in the character of the tumour, an attempt should be made to remove it, or to cut away the bone if that should be found to be implicated, and as a last resource, to perform the Cæsarean section.