original pelvic presentations. I allude to the locking of the head above the brim of the pelvis, which becomes keyed there by the forearm; the elbow being elevated, and the hand projecting backwards behind the nucha, it serves as a key to prevent the head from sinking into the excavation. When the pressure, in consequence of aggravated contractions of the womb, becomes very great, it is nearly impossible to disengage the hand from behind the neck, by depressing the elbow by means of the fingers in the way formerly pointed out;-it is easier to break the delicate bone of the humerus than to bring the elbow down. Dr. Dewees's method, one upon which he strongly insisted in his lectures, was to pass two fingers upwards in front of the shoulderjoint, and two fingers up against the opposite scapula. By means of the pressure in contrary directions of these two opposite hands, the thorax of the child is made to revolve upon its axis one quarter of a circle; the hand is disengaged from behind the throat by this rotation, and immediately afterwards brought down by pulling at the bend of the elbow.

It has been proposed to bring the head back to the brim of the pelvis. I have attempted to succeed in this version by the head, but have always signally failed, with the exception of a case related in a former page of this work. In that instance, I succeeded by means of pressure made upon the external surface of the abdomen. The attempt might always be made with propriety in those cases in which the contractions of the womb have not as yet driven the presenting parts firmly into the opening. With a loose and flaccid uterus, the Student might have the good fortune, after lifting the shoulder out of the way, to lodge the head fairly in his palm, and pushing the fundus uteri in an opposite direction so as to raise the breech of the child, draw the head to the abdominal strait and let it engage therein. I think no very violent efforts should be made to effect this kind of version; and it must be rarely that the os uteri will be found sufficiently dilated to allow of the operation being even attempted-for, when the os is well opened, the presenting part is already far down in the excavation.

CHAPTER XIV.

PRETERNATURAL LABOR FROM DEFORMED PELVIS.

IN former pages of this work, to wit, in Chapter I., I treated of the pelvis as normally constituted. The Student, from reading that chapter, has become acquainted with the dimensions of the planes of the two straits, and with the excavation.

He knows that the osseous frame consists of a soft gelatinous material which hath become rigid and extremely solid and compact by the deposit within it of phosphate of lime. He knows that to macerate a bone in a strong acid solution is to dissolve out from it the whole of its calcareous solid matter, leaving to the bone its pristine form and dimensions, but leaving it, at the same time, compressible and flexible in every direction; for all that is left of the bone after the maceration. is a gelatinous mixed with a fibrous and cellular material.

Now the child that is born may become, in one of the early years of its existence, the subject of a disease, one of whose most prominent characteristics is to prevent a deposition of the calcareous phosphate in the substance of the gelatinous framework of the bone; not wholly, indeed, but to such a degree as to leave the bone softish and compressible, or flexible. Again, a child may grow up in apparent health, having conformably developed all the parts of its constitution—its phosphatic deposits having been completely made up to a certain term, and giving to its bones a due degree of solidity and firmness; whereupon it may be attacked with disease, whose effect shall be to remove from the gelatinous framework of its bones a large proportion of the calcareous portion already deposited.

These two cases present examples, the one of a suspension of the process of deposition, and the other of a removal of the phosphates already deposited. The former is Rachitis, or Rickets. The latter is Mollities ossium, or softening of the bones. The effect is the same in either case. In rachitis, the child continues to grow without removal of the ancient phosphate, and the bone bends or is crushed. In the

latter the ancient phosphate is removed and the bone bends, or is crushed. It bends, or is crushed under superincumbent weight. If the child laboring under rachitis should recover from that malady, it would regain its power to solidify its bone by depositing calcareous matter within its intimate structure. But, should the solid matter be replaced while the bone in its plastic condition is pressed or bent out of its due shape, it might acquire the most consummate health, and remain ever after affected with the deformity.

If the humerus, the radius, the femur, or the tibia should regain its solid phosphate, those several bones would be found arcuated-beut like a bow-and remain ever so. If the ossa innominata, which consist of the ilia, ischia, and pubes, should be the seat of the softening processes, and if during a long-protracted illness, the child should lie chiefly upon her right side, or upon her left buttock, the sacro-pubal diameter of the pelvis would allow its pubic extremity to be turned towards the right side of the child, and vice versa. This would produce what is called the obliquely deformed pelvis-dass schraage verengte beckens-of Professor Nægèle of Heidelberg, for the wing of the sacrum of the lower side would not grow as rapidly as the opposite one. It is, however, to be understood that where the wing of the sacrum is faulty, there is reason to believe it may have been so in an early embryonal stage.

The Student will perceive that such a pelvis as this must lose a portion of that diameter which extends from the left acetabulum to the right sacro-iliac symphysis, provided the pubis be deflected to the right side, and so, mutatis mutandis.

In case the Student should be charged with the conduct of labor for a woman affected with right oblique deformed pelvis, he will perceive the necessity there is to direct, if possible, the vertex of the child to the right rather than to the left acetabulum of the mother; for, as the occipito-frontal diameter of the foetus exceeds its bi-parietal diameter, he would sedulously endeavor to make the greatest diameter of the head coincide with the greatest diameter of the pelvis, in order to render easiera delivery, which would be difficult, laborious, and even impracticable, were he to persist in attempts to force the long diameter of the head through the contracted diagonal of the pelvis. This is one of the cases in which turning and delivery by the feet are allowable in deformed pelvis.

Having made a perfect diagnosis of the deformity, he will find himself able, in performing the act of version, to adjust the smallest diameters of the foetal cranium in such a way as to make them coincide with the smallest diameters of the pelvic passages.

The annexed figure (109), taken from Professor Nægèle's work on

the oblique-deformed pelvis,

shows that, if the vertex should be directed towards the left acetabulum, the dimensions of the strait are so much altered there by the fall of the pubis towards the right, that little expectation could be indulged of the descent of the cranium below the plane; for the antero-posterior diameter of the cranium exceeds four inches and a half, while the bi-parietal diameter is 3.88.

Fig. 109.

I subjoin the figure of a pelvis preserved in my collection (Fig. 110). It will be seen that it is right oblique deformed, like that described by Professor Nægèle. Its dimensions, which I now carefully measure, are from the promontory of the sacrum to the top of the symphysis

Fig. 110.

pubis, 3.6; from the promontory of the sacrum to the point of the coccyx, 3.5; from the right acetabulum to the left sacro-iliac junction, 4.1; from the left acetabulum to the right sacro-iliac junction, 2.7; from the top of the right ischium to the top of the left ischium, 3.7;

from the inner lip of the right tuber ischii to that of the left tuber ischii, 3.5; from the point of the coccyx to the crown of the pubal arch, 4.2; from the point of the coccyx to the inner lip of the left tuber, 1.9; to the right tuber, 3.5; the length of the symphysis pubis, 1.

Fig. 111.

I shall proceed now to speak of other deformities of the pelvis. Rachitis or Mollities does not necessarily affect the whole of a bone. The figure 111, which I subjoin, represents the plane of a superior strait like the figure 8. It is evident upon inspection that the posterior semi-circumference of the pelvis has not suffered at all in its form, as the Student may perceive

by comparing it with Fig. 112, which I have taken from the pelvis of an Egyptian lady of rank from the tombs of Thebes, which specimen was presented to me by my friend, the late Samuel George Morton, the distinguished author of the Crania Americana. This pelvis, which

Fig. 112.

is one of the most perfect specimens of the female pelvis that I have ever seen, may serve as a means of comparing the posterior semi-circumference of the badly deformed pelvis, Fig. 111, with the posterior semi-circumference of this most perfect Egyptian form. It shows that the deformity in Fig. 111 has arisen from rachitis or mollities affecting chiefly the pubal and ischial portions of its ossa innominata, which, having fallen inwards upon the promontorium of the sacrum, have so reduced the antero-posterior diameter of the superior strait as to render the passage wholly impracticable for the full grown fœtus.