692 
PARTURITION. 
weight of the body ; and that, by the manner of its 
junction with the laft of the vertebrae, a confiderable an¬ 
gle is made, which, if but little increafed,'will caufe a 
very important change in the form and dimenfions of the 
fuperior aperture of the pelvis. In fome cafes an irregu¬ 
lar convexity, and in others a concavity, are produced by 
the bending of the ofia pubis in different ways and de¬ 
grees ; by which, together with the projection of the fa- 
crum and lumbar vertebrae, the dimenfions of the fupe¬ 
rior aperture of the pelvis, which in the narrowed: part 
fhould exceed four inches, are reduced to lefs than one, 
and altered in every pofiible direction. 
Various means have been recommended for accurately 
meafuring the dimenfions of the pelvis; and the inge¬ 
nuity of foreign accoucheurs has produced a number of 
different inftruments, called pelvimeters, which are fup- 
pofed to afeertain this point with great precifion. But 
there is, probably, more of inaccuracy in this mode of ad- 
meafurement on the living body, than at fir ft fight may 
appear ; and certainly the inferences drawn from luch ad- 
meafurements, and the modes of pradtice in confequence 
recommended, have fometimes been grofsly unfcientific. 
In England we are more in the habit of examining the 
fize of the pelvis by our fingers than by pelvimeters ; and 
Dr. Conqueft fays, that “all pelvimeters but the fingers 
are ridiculous and ufelefs ;” but, upon a point of fo 
much confequence, we fhould do well to take every pof- 
fible means of afeertaining with precifion the real di¬ 
menfions, and might therefore advantageoully call to 
our aid the occafional ufe of the pelvimeter. 
Dr. Olborn, who took great pains in invefeigating the 
bell method of procedure in cafes of diftorted pelvis, 
conliders, that a foetus, at full maturity cannot pafs alive, 
if the dimenfions of the pelvis, from the pubes to the 
projedlion of the facrum, be only z\ inches; and Dr. 
Clarke of Dublin fays, that 35 inches from the pubes to 
the facrum is the leaft diameter through which he has 
known a full grown fetus to pafs entire; but, as it has 
been afeertained by Dr. Hamilton, that children have 
been born living, though the pelvis in this diameter was 
“ manifeftly under three inches,” it is neceflary, that 
pradtitioners of midwifery fhould be very much upon 
their guard againft being deceived in their eftimate of 
the adtual dimenfions. 
When, however, the diftortion is fo very confiderable, 
as muft fatisfy us, upon the firft examination, of the im- 
poffibility of effecting the birth, alive, in the ufual way, 
we are then reduced to the dreadful alternative, of either 
killing the child, and bringing it away piecemeal, to 
fave the mother, by the operation called embryotomy , or 
e.mbryuleia; or of (molt probably) killing the mother to 
fave the child, by that moll Ihocking of all operations, 
•the Cefarian Jedlion. 
For women who are known to have a narrow or de¬ 
formed pelvis, or who have previoufly fuffered the ope¬ 
ration of embryotomy, three modes have been propofed 
for avoiding the dangers we have mentioned. 
1. Abjlinence .—This meafure was recommended by 
Mr. James Lucas, furgeon to the infirmary at Leeds, in 
a paper publifhed in the fecond volume of the Memoirs 
of the Medical Society of London ; and he has related fe- 
veral inltances, by which he attempts to fliow, that ab- 
llemious diet, with occafional blood-letting, and a mo¬ 
derate ufe of aperients, has tended toreltrain the growth 
of the fetus, and to render the bones of the head more 
yielding. There can be no doubt, where well-formed 
women are accullomed to have difficult labours, front 
the large fize of the child, that this method may be oc- 
caiionally uleful; and in a few cafes of deformed pelvis, 
where the deformity is not very great, fome good might 
refult front it. But the expedted benefits feem to be con¬ 
fined within very narrow limits, and therefore this plan 
.can only be occafionally ufeful. 
Signor Alfalini relates a cafe, (1811.) in which abfti- 
iience was ufefully enjoined ; but remarks that no great 
reliance is to be placed upon it; for women who cori- 
ftantly rejedt by vomiting every particle of food they 
fwallow, have, notwithllanding, on many occafions large 
children ; and Dr. Merriman has, in his Appendix, given 
three cafes, from which it may be inferred, that (lender 
diet, befides the injury it may do to the general health, 
is by no means to be depended upon for preventing the 
growth of the fetus, or for producing a child worth 
rearing. 
2. Premature Labour .—The pradtitioners of midwifery 
could not fail to have obferved, that on many occafions 
of diftorted pelvis, children at feven months, witen labour 
was accidentally excited at that period, have palled with 
comparative eafe, and been born alive ; though, when 
they reached the full term of utero-gellation, they fell 
facrifices to the difficulty of the labour. Smellie men¬ 
tions feveral fuch cafes, particularly of a woman whofe 
pelvis meafured lefs than two inches and a half of conju¬ 
gate diameter; the had been five times delivered, “and 
only one child was laved by being born in the eighth 
month, of a very frnall fize.” 
When it was once afeertained, that fpontaneous or 
accidental premature labour, w'as thus ferviceable in pre- 
lerving the lives of children in cafes of diftorted pelvis, 
it was natural to confider whether the artificial induce¬ 
ment of labour would not be attended with equal fuc- 
cefs; and accordingly, as we are informed by Dr. Den¬ 
man, there was, in 1756, “a confultation of the molt 
eminent men in London at that time, to confider of the 
moral redtitude of, and advantages which might be ex¬ 
pected from, this practice, which met with their general 
approbation.” 
To fay that no danger is incurred by the mother from 
fuch an operation, would be to aflert what is contrary to 
fadt; for no doubt can be made, that feveral women have 
loft their lives by it; but it may be truly faid, that the 
woman, who is to undergo the operation of having the 
child extracted piecemeal, is always placed in at leaft as 
much, if not in more, danger. What has been the fuc- 
cefs of this pradtice in prelerving the lives of children, 
cannot perhaps be exadtly afeertained ; but Dr. Merri¬ 
man has given the particulars of 33 cafes of labours pre¬ 
maturely induced, in the eighth month of pregnancy, on 
account of extreme diftortion of the pelvis. In 21 of 
thefe the children were born dead; 4. w’ere born alive, but 
incapable of living more than a few hours ; 9 were born 
alive, and capable of being reared. Thus nearly one- 
third of the children were faved, who muft have loft their 
lives, had the women gone to their full times, and been 
delivered by piecemeal: and all the icomen recovered, 
the majority of whom muft have been loft, had the Casfa- 
rean fedtion been performed. 
It is of the utmoll confequence, in recommending this 
pradtice, that the principles, upon which alone it feems 
juftifiable, fhould be duly weighed and confidered. It 
ought not to be concealed, that it has been had recourfe 
to, by wicked and unprincipled perfons, for the atrocious 
and criminal purpofe of procuring abortion : and fome¬ 
times has been unneceflarily adopted by the ignorant or 
incautious. It is therefore incumbent upon all, w'ho with 
to lteer clear of either of the above imputations, fo to 
adt, that, fhould any judicial inquiry be inftituted, they 
may be able to affign a juft and latisfadtory reafon for 
their condudt. The poflibility of fuch an inquiry is by 
no means to be treated (lightly. A phyfician, whofe 
motives could only be praife-w'orthy,was lately threatened 
with a profecution, for propofing fuch an operation; 
and it is not long fince an accoucheur of eminence was, 
on an occafion of this kind, called before a coroner’s 
jury, to account for his condudt, which he did moll fa- 
tisfadtorily and honourably. 
As the primary objedt is to preferve the life of the 
child, the operation fhould never be undertaken till 
feven complete months of utero-geftation have elapfed: 
and, if the pelvis of the mother be not too much con- 
tradted 
