A practical treatise on midwifery : exhibiting the present advanced state of the science / by F.J. Moreau ; translated from the French by Thomas Forrest Betton and edited by Paul B. Goddard.

  • Moreau, François-Joseph, 1789-1862.
Date:
1844
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on midwifery : exhibiting the present advanced state of the science / by F.J. Moreau ; translated from the French by Thomas Forrest Betton and edited by Paul B. Goddard. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    inferior limit of the internal iliac fossa. From this triangular surface arises the ilio-pectineal protuberance, into which is inserted the p parvus muscle, when it exists. At the apex of the triangle is the spine of the pubes, projecting under the skin in persons who are not very corpulent; it gives origin to the rectus abdominis, as well as to the pyramidalis muscle, and receives the external column of the inguinal ring. The horizontal portion of the anterior edge is terminated by the angle of the pubes, nearly straight, formed by the union of the anterior and inferior edgesj and which we must be careful not to confound with the spine. The posterior edge, arising from the posterior superior spinous process of the ilium, presents, beneath this process, a notch which rates it from another eminence called posterior inferior spinous process: the latter gives externally attachment to ligaments, and tonus internally the small extremity of the sacro-iliac symphysis. Below is the great ischicitic notch, two inches in depth, covered by a ligamentous and aponeurotic expansion; it terminates inferiorly by an acute and sharp spine, known by the name of spine of the ischium. Between this spine and the tuberosity of the ischium, is found the lesser ischiatic notch, in which the tendon of the obturator interims plays. Like all the broad bones, the innominatum is composed of spongy and compact tissue, and varies in size in different portions of its extent; it is very thick at the crest of the ilium, the tuberosity of the ischium, the posterior and superior part of the acetabulum, and thin in the concave part of the iliac fossa and at the bottom of the cotyloid cavity. This bone is articulated with the sacrum by the sacro-iliac symphysis, with the femur by the cotyloid cavity, and with its fellow by the symphysis pubis. The development of the coxal bone presents some curious peculiarities, which have only lately been well understood. Its existence is indicated by three primitive points of ossification, to which are added five other secondary points. Of the primitive points, the first is seen in the ilium, fifty days after conception; the second in the ischium, at the end of the third month; and the third in the pubes, during the fifth month. From this original separation of the bone into three parts, it has been considered as being formed by three bones called ilium, ischium, and pubes. The ilium constitutes the flat part of the bone and the superior portion of the cotyloid cavity. The pubes comprises, 1st, the internal part of the cotyloid cavity; 2d, the horizontal part called body of the pubes, which limits above the obturator foramen; 3d, the descending ramus of the pubes, which bounds this same foramen inwardly: this ramus does not descend vertically, but, on the contrary, departs from its opposite fellow, leaving a space resembling an inverted V. This arrangement, much more remarkable in the female than in the male, is well calculated to assist the passage of the child. Lastly, the ischium is composed, 1st, of the body of the ischium, almost vertical, thick, prismatic, triangular, bounding outwardly the obturator foramen, and of which the inferior portion is formed by the tuberosity of the ischium; 2d, of the ascending ramus of the ischium, oblique, limiting internally the sub-pubic hole, and extending toward the descending ramus of the pubes ; 3d, of the inferior portion of the acetabulum. In the foetus, at full term, we find only three parts ossified, the ilium, the horizontal branch of the pubes, and the sub-acetabular portion of the ischium; all the rest is cartilaginous. The limits of these parts are marked in the base of the cotyloid cavity by an intermediate cartilage in the shape of the letter Y. From thirteen to fifteen years of age, the ossification of the cavity is completed. The secondary points appear also at that period, viz : the marginal epiphysis, constituting the crest of the ilium, the epiphysis of the tuberosity of the ischium, the two epiphyses of the anterior inferior spinous processes of the ilium, and of the angle of the pubes; lastly, the edge of the cotyloid cavity, pointed out by M. Serres. These different epiphyses are not permanently consolidated with the body of the bone, until the age of eighteen or twenty years. We must likewise except the crista of the ilium, which does not unite until the twenty-second, twenty- fourth, and even the twenty-fifth year. ARTICLE II.—OF THE SYMPHYSES, OR ARTICULATIONS OF THE BONES OF THE PELVIS. The bones of the pelvis are united together by means of articulations and ligaments. The articulations, four in number, are designated by the generic term of symphyses: each symphysis has a peculiar name derived from the bones Avhich form it, and they are hence called pubic—sacro-iliac—sacro-coccygeal. The ligaments—of which there are six, three on each side—are the great and small sacro-sciatic, and the obturator. The articulations of the pelvis may be the seat of more or less serious alterations and lesions, either during pregnancy or during the progress of a natural labour, or in cases of artificial delivery: they therefore deserve a most careful study. § I. OF THE SYMPHYSIS PUBIS. The pubic articulation or symphysis is formed by the approximation of the two articular facets of the pubes, by an intermediate fibro-cartilage, and by ligamentous fasculi surrounding these parts. Each articular surface of the pubes is clothed with a fibro-cartilage, which, united to its opposite fellow, forms a species of wedge, of which the edge, directed toward the posterior part of the articulation, sometimes projects on that side, whilst the base is turned to the front: whence it follows that the bones of the pubes, which, when seen from the pelvic cavity, appear to touch each other, are separated in front to the distance of several lines. At the middle of the symphysis and towards the posterior third of the fibro-cartilage, are seen two articular surfaces, smooth, polished, oblong, covered by cartilage, and apparently lined by a synovial membrane. In order to perceive this structure, we should examine the body of a woman who has died in the last stage of utero-gestation, or soon after delivery: at other times, and for a still stronger reason, in man it is more difficult to discover. From the fibro-cartilage which covers each one of the pubes, proceed transverse, short, thick fibres, situated the nearer to each other as we approach the superior and inferior parts of the symphysis: these fibres, numerous in the male, diminish as they approach the centre of the articulation, and in many women are wanting at the posterior part of the symphysis.