PROLAPSUS UTERI.
Falling of the womb may retard labor, but is not likely to make it more than usually difficult, nor dangerous. It is requisite, however to bear in mind that the head of the child may, by this displacement, be found in the vagina, and even at the vulva, before it has passed through the mouth of the womb, because the neck itself is already in the passage. The head may therefore be felt low down, and the accoucheur may think the labor will soon be completed, when in reality it has scarcely begun. In such cases it merely requires patience and non-interference.
In my work on the Diseases of Women, will be found many curious cases of pregnancy and delivery, occurring during partial or complete prolapsus uteri; and also much information regarding obliquity, and other similar derangements.
SMALLNESS OR DEFORMITY OF THE PELVIS.
These constitute by far the most serious obstacles to delivery, and are most to be dreaded. In treating upon them it will be first necessary to explain the chief kinds of deformities, and the cause from which they arise, after which it can be shown how they interfere with the progress of labor, and how they can be best remedied.
Deformities of the pelvis may either be congenital, or they may be produced by certain diseases in after life, and also by bad physical education. The principal causes however are two diseases, Rachitis, or Rickets, and Malacosteon, called also Mollites Ossium, or softening of the bones. Rachitis usually attacks children somewhere between nine months and two years of age, and produces a variety of well marked symptoms; such as large head and belly, protrusion of the breast-bone, flattening of the ribs, emaciation of the limbs, and various deformities of the bones. The patient may recover from the disease, but the deformity of the bones often remains, and therefore no female should become pregnant, who has had rickets, till the shape and dimensions of her pelvis are known, or it may cost her life.
Malacosteon or softening of the bones, may come on at any period of life, and frequently occurs without any serious constitutional disturbance. It consists in a gradual absorption from the bones of all their solid matter, so that they become soft, and may be bent or twisted like horn. Sometimes this state will be reached very soon, but at other times the disease progresses very slowly. The causes of it are unknown, and it is incurable. I have seen a patient who could bend the bone of her leg nearly double, as if it were a piece of rope.
In my work on the Diseases of Woman, I have spoken upon various other causes which may deform the bones in young females, such as wearing corsets, improper attitudes in sitting, and want of sufficient unconstrained exertion of the body in the open air.
The deformities may be of various kinds, and may either alter the general appearance and the walk, or may not be discoverable except on examination. Sometimes the pelvis is too large, so that the womb and other parts are continually falling down into its cavity, but this is very rarely seen; more frequently it is either too small, or irregular in its form.