Selected monographs.

  • New Sydenham Society.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    322/372 (page 18)
    between the crests of ilia was 275 cm., and that between the trochanters 27 cm., and therefore only 0*5 cm. less, while the distance between the tubers of the ischia was 6*0 cm., and there- fore the external kyphotic character of her pelvis was far more developed, the natural forces were sufficient to cause the advance of the foetal head as far as the pelvic outlet, and the pregnancy terminated normally in the birth of a living child, while in other cases, in which the external kyphotic character of the pelvis has been far less developed, the delivery has been fatal to mother or child, or to both. I cannot here digress to enter on this most interesting obstetric question, which I must leave for a separate work. I would only insist that the danger attending a delivery cannot be estimated from the external dimensions of the pelvis by themselves, nor is obstetric aid to be doled out by centi- metres. One may indeed determine the amount of contraction in the outlet and cavity, and in favourable cases where the head presents and is still movable even that of the anatomical inlet, of the pelvis, but when labour is going on we cannot make an exact estimate of the contraction in the median plane above the plane of the anatomical inlet to the pelvis, the very seat in many cases of the greatest obstacle to delivery, of the greatest con- traction. That not only during labour itself, but even when pregnancy is not far advanced, it may be very difficult under certain circumstances to feel the lumbar vertebral column in the plane of the anatomical pelvic inlet, or even somewhat lower down, was proved in the first Dresden case, in which at his first inde- pendent examination Winckel was unable to reach the lumbar column or angle of dislocation per vaginam, and only concurred with my diagnosis after he had again examined the woman lying on her side. Indeed in one case in practice, in which it was stated that on account of the foetal parts presenting, the lumbar column could not be distinctly made out per vaginam, the obstetrician in attendance quite disregarding on that account the angle of dislocation, made his diagnosis of spondylolisthesis only on the external kyphotic form of the pelvis, the attitude of the body, &c, &c, combined with the absence of any kyphotic lumbo-sacral convexity. The place of the greatest contraction, whether in the median plane, or if the case is complicated by scoliosis, in a somewhat extramedian but parallel plane, is often out of the reach of digital examination per vaginam or per