On Diminution of the size of the Child by Regimen and Venesec-
tion. By M. Depaul.—M. Depaul, fully appreciating, the advantages
derivable from the induction of premature labor in contracted pelvis, yet
believes that the necessity of doing this may be avoided in certain
cases, by submitting the mother to regimen and repeated venesection.
His attention was first directed to the subject by hearing M. Moreau,
in his lectures, express a favorable opinion upon the feasibility of the
procedure, founded upon a case that had occurred to him. M. Moreau
had attended a woman in two labors, which were very difficult ones, in
consequence of considerable pelvic contraction. Apprised that she
had again become pregnant, he submitted her to a severe regimen and
repeated venesection, and the result was, that a small living infant
passed without any aid. In a later pregnancy, she was not submitted
to any regimen, embryotomy was had recourse to, and both mother and
child died. M. Moreau has since met with other similar cases ; but
he believes that when the antqro-posterior diameter of the pelvis is less
than 3£ inches (French), or, at most, 3 inches, regimen can only be
relied upon as an auxiliary. The influence of feeding on the size of
the young, is well known in rural districts and to veterinarians ; while
in women who reject nearly all their food during pregnancy, the child
is often very small. This is also the case with the women that come
to the Maternite to be confined, after undergoing the greatest privations
during pregnancy.
Dr. Depaul relates two cases which have occurred in his own practice.
Madame G---------, of small stature, and having some degree of contrac-
tion of the pelvis from rickets, bore, in 1843, a full-sized, still-born
child, after a very difficult labor, and the use of ergot. In 1846, she
was delivered of a large, still born child by the forceps. She con-
ceived again, November 21st, 1847 ; and although the induction of
premature labor had been predetermined upon in the event of another
pregnancy, yet she earnestly entreated that a full trial should be given
to regimen. Accordingly, from February, her diet was limited to
potages and vegetables, a little meat once a week, and half a pound of
bread per diem ; and although a healthy person, with vigorous appetite,
she cheerfully submitted to the privation. About 400 grammes of blood
were abstracted from her arm in the 3d, 6th, 8th, and 8|th month.
She became pale and thin. On the 19th of Augnst, labor commenced,
and was rapidly finished. The child was small, weighing only 51bs.
(the two others had each weighed 91bs.), but cried and did well. The
mother now allowing herself a better diet, soon recovered her strength.
The subject of the second case had been formerly attended by M. P.
Dubois, who, finding a rickety pelvis, contracted to 3 inches, had per-
forated the child’s head. On the present occasion he had recommended
the induction of premature labor at the 8th month. Labor-pains, how-
ever, set in of their own accord, and the author, summoned in the ab-
sence of M. Dubois, brought away a small, living child, by means of
the forceps. It weighed 2600 grammes, and the bones of its skull were
of remarkable thinness. It was discovered afterwards, that this woman
had really gone her full time, having, after various futile attempts at
procuring abortion at an early stage, resolved to submit herself to a de-
bilitating regimen. This she commenced at the second month, being
then rather stout, and having an excellent appetite ; and she throughout
continued an almost starvation regimen. At first she was much tor-
mented by epigastric pain and intense thirst, requiring large quantities
of water to allay it, and she soon became very thin and feeble ; but
having become accustomed to her privation, she suffered, during the
last three months but little from its continuance. After her confinement,
a judicious diet soon restored her strength and flesh, and she was able
to suckle her child. This case is therefore more satisfactory than the
former, inasmuch as the same end was obtained without resorting to
venesection.
The procedure would be justifiable in those cases in which the wo-
man, without having any notable diminution of the pelvis, yet always
brings forth, owing to their size, only dead children. In moderate con-
traction of the pelvis, too, it may be resorted to, and although not
available in cases of excessive contraction, it may even here be used as
an auxiliary, to delay somewhat longer the period of inducing prema-
ture labor, and thus give the child an additional chance of life. During
the progress of the case, frequent examination should be made, so that
we may ascertain, by the degree of development of the uterus, the mo-
bility of the child, and the abundance of the liq. amnii, how far our
success is probable. If from this, we conclude our end cannot be
gained, we should resort to artificial means for terminating the preg-
nancy. It is not desirable to commence the debilitating regimen, prior
to the 3d or 4th month, as before that period the development of the
foetus takes place very slowly, and the pregnancy is much more easily
endangered by whatever affects the maternal system. It would, too,
be probably better, if the amount of aliments were gradually diminished,
so as the more easily to accommodate the system to so painful and so
prolonged an experiment. The strong meats should be quite abstained
from, and, as a general rule, three fourths of the nutriment should be
cut off. Much will depend upon the state of the circulation in guiding
our decision as to the employment of venesection.—Bulk de Therapeu-
tique, from Brit, and For. Med. Chir. Rev.
QWhen we bear ip mind, that women who have suffered during their
entire pregnancy from excessive sickness (M. Depaul, however, states
that some of these do not reject their aliments), and others, whose sys-
tem has become exhausted by want or disease, yet sometimes bring forth
voluminous children, it is evident that M. Depaul’s recommendation
does not admit of a large generalization. Indeed, with some women,
the production of large children seems to be as natural as the posses-
sion of any personal peculiarity, and by no means dependent upon the
mode of life they adopt. Still, there are cases of deformed pelvis,
where it may be of great importance to have a living child, in which
the plan is well worthy of a trial; for if, by its agency, a small, living
child is born at its full time, its chances of surviving will, doubtless,
be very superior to those even of a larger infant prematurely brought
forth.]—Brit, and For. Med. C/iir. Rev.