Part 19 (1/2)

2. Labours which are rendered faulty without obstruction to their progress.

The first division of dystocia may either arise from a faulty condition of the expelling powers, or, without any anormality in this respect, it may depend upon the faulty condition either of the child, or of the parts through which it has to pa.s.s.

As respects the child it may arise from,

1. Malposition.

2. Faulty form and size of the child.

3. Faulty condition of the parts which belong to the child.

On the part of the mother this division of dystocia may arise from a faulty condition.

4. Of the pelvis.

5. Of the soft pa.s.sages.

6. Of the expelling powers.

The second condition where labour is rendered dangerous for the mother or her child, without any obstruction to its progress, may arise from,

1. Following too rapid a course.

2. Prolapsus, &c. of the umbilical cord.

3. From accidental circ.u.mstances, which render the labour dangerous, viz.

convulsion, syncope, dyspnoea, severe and continued vomiting, haemorrhage, &c.

We propose to consider the different species of dystocia in the order above enumerated.

CHAPTER I.

FIRST SPECIES OF DYSTOCIA.

_Malposition of the child.--Arm or shoulder the only faulty position of a full-grown living foetus.--Causes of malposition.--Diagnosis before and during labour.--Results where no a.s.sistance is rendered.-- Spontaneous expulsion.--Malposition complicated with deformed pelvis or spasmodically contracted uterus.--Embryulcia.--The prolapsed arm not to be put back or amputated.--Presentation of the arm and head.-- Presentation of the hand and feet.--Presentation of the head and feet.--Rupture of the uterus.--Usual seat of laceration.--Causes.-- Premonitory symptoms.--Symptoms.--Treatment.--Gastrotomy.--Rupture in the early months of pregnancy._

We have already stated that the presentations of the full-grown living foetus may be brought under three cla.s.ses, viz. those of the head, of the nates or lower extremities, and of the arm or shoulder: the former two have already been considered under the head of eutocia or healthy parturition, and may be distinguished from the latter, by the great peculiarity that in them the long axis of the child's body is parallel with that of the uterus, whereas, in arm or shoulder presentations this cannot be the case, its body lying across the uterus.

Although malposition of the child, strictly speaking, refers to one species of presentation only, viz. to that of the arm or shoulder, yet it has been rendered a matter of great perplexity by the speculations and theoretical notions of authors. No one has propagated more serious errors upon this subject than the celebrated Baudelocque, the more so as the great authority of his name has tended to silence all doubts as to the accuracy of his views upon this subject. Almost every author since his time has contented himself with copying more or less from him, without ascertaining by personal observation how far they corresponded with the actual course of nature. By forcing a stuffed figure into a pelvis in every possible direction, he succeeded in making actually ninety-four presentations of the child, all of which he described as if they had really occurred in nature.

Few have taken so simple a view of this subject as the late Dr. Denman.

”The presentations of children at the time of birth,” says this distinguished accoucheur, ”may be of three kinds, viz. the head, the breech or inferior extremities, the shoulder or superior extremities; the back, belly, breast or sides, properly speaking, never const.i.tute the presenting part.”

The two greatest Continental authorities of modern times, viz. Madame La Chapelle and Professor Naegele, confirm this opinion: the former points out one of the sources of error which has induced pract.i.tioners to suppose that they had met with other species of faulty presentation besides those of the arm or shoulder. ”In the greater number of shoulder presentations,”

says this experienced auth.o.r.ess, ”I have very distinctly touched the chest, in some positions of the nates I have been able to reach the loins, the hips, or lower part of the abdomen; but it would require no slight bias from prejudice and theoretical systems to find presentations of the chest, the back, the abdomen, or the loins, the neck or the ear.”[108]

We would, therefore, limit the term malposition of the child merely to presentations of the arm or shoulder: other presentations, it is true, occur, but not of the full-grown living foetus; they are only where the child is premature, or has been dead in utero some time. Under such circ.u.mstances it will follow no rule whatever; for in the first case it is too small, and therefore the pa.s.sages can have no effect in directing its course through them; and, in the second, a child which has been dead some time becomes so softened by gradual decomposition, that it may be squeezed by the pressure of the uterus into almost any shape: it is by this cause that we occasionally see in still-born children parts in close contact, which in a living child could not have been brought together.