Injuries of nerves and their consequences - Reflex Sympathetic ...

VARIETIES OF MECHANICAL INJURIES OF NERVES. 123
accomplished, and was speedily followed by
the pain, uumbness, and swelling.
relief from
Compression of nerves during delivery. — Cases of paralysis
of one or both lower limbs are somewhat rare sequelae of
confinements. Thej' may be traced to a variety of causes,
among which are undoubtedly the pressure of the foetal
head or of the forceps.
Although frequently denied as a cause of pals}^, pressure
is now, and has been for a long time, admitted by
all the
prominent writers upon the complications and results of
labor. The subject is
admirably treated in all its relations
by Bianchi,* to whose excellent pamphlet I am largely
indebted.
This form of accident in some cases immediately succeeds
the passage of the fcetal head ;
in others it is
delayed
several days. In the latter, however, at least in the instances
I myself have seen, there were uumbness and
hypertesthesia, which deepened by degrees, and finally
ended in partial palsy, a sequence due sometimes to the
pressure having occasioned a gradually-increasing neu-
seen in the contusion of nerves elsewhere.
ritis, just as is
In many labors, as every accoucheur is aware, cramppain
from pressure
is met with. The nerves which may
be thus, or more gravely, aflfected, are the crural, obturator,
and sciatic. The first named is apt to suffer during
the earlier stages of labor, and, as Burnsf has pointed out,
to occasion pain in the front of the thigh.
Severer injury to this trunk is unlikely, owing to its
protection by the psoas and iliacus muscles. The obturator
nerve is also liable to pressure, and to give rise to
similar but passing pains. Within the pelvic excavation
* Des Paralysies traumatiques des Membres Inferieurs chez des Nouvelles-Accouchees.
These de Paris, 1867.
f Burns's Midwifery, p. 14.