Is pubiotomy a justifiable operation? : [second communication based upon a series of twenty-five successful cases] / by J. Whitridge Williams.

  • Williams, J. Whitridge (John Whitridge), 1866-1931.
Date:
1910
Catalogue details

Licence: In copyright

Credit: Is pubiotomy a justifiable operation? : [second communication based upon a series of twenty-five successful cases] / by J. Whitridge Williams. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the pelvic cavity. From these reports and my own experience it would therefore seem that fibrous healing is the rule and bony union the exception. The findings at the site of the bone section, likewise, vary considerably according as the patient is examined within a few weeks or after a longer period. In the first instance there is usually considerable thickening upon the anterior surface of the pubic bone, while no trace of the incision can be felt upon its posterior surface. On the other hand, a subsequent examination will frequently show that the anterior thickening has disappeared, while the site of the incision on the posterior surface may be indicated by a shallow depression, which some- times terminates by a slight notch at its superior and inferior extremity. Only once in our series of cases could definite separation between the ends of the bone be detected on palpation (case XXIV), but in this instance a shallow groove i cm. in width lay between them, and buckled slightly upon passive movement of the thigh. Effect Upon the Pelvis.—Upon reexamination all of my patients were subjected to careful mensuration for the purpose of deter- mining w'hat effect, if any, the operation had exerted upon the size of the pelvis. Changes were noted in eleven instances: cases II, VI, VII, XI, XV, XVI, XVII, XVIII, XIX, XXIII, and XIV. In several they were so slight that it was questionable whether they were due to actual enlargement or merely to some slight error in pelvimetry. In others, on the contrary, the changes were so pronounced that there could be no doubt as to their significance. In eight patients the distance between the tubera ischii had undoubtedly become increased following the operation. This varied from i to 2 1/2 cm., and in several instances, as will be pointed out later, apparently led to sufficient enlargement to make possible the spontaneous ending of subsequent labors. The increase in the diagonal conjugate was less marked, but in five patients the measurement was 0.5 to 1.25 cm. longer than previously, while in two it was also associated with an in- crease in the distance between the tubera ischii. These findings are of considerable interest, as they appear to indicate that permanent enlargement of the pelvis may occur in something less than one-half of the cases, and is more pronounced in the transverse diameter of the outlet than at the superior strait. Moreover, to a certain extent, they appear to be contra- dictory of the statement of Mayer, who holds that the practical