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)

    334/372 (page 30)
    tion of the vertebral column cannot take place without an accom- panying condition of irritability in the surrounding soft parts. Quite apart, however, from this, and from the history of the case, several other points corroborate the diagnosis. As has been stated, the angle of dislocation was on one occasion felt below the level of the anterior superior margin of the os sacrum, while in a case of lumbo-sacral spondylizematic kyphosis the apex of the angle of flexion is situated exactly at this margin, and there- fore the finger tip passing outwards on either side from this angle of flexion must hit upon the anterior edges of the lateral masses of the sacrum. Moreover, the thickness of the posterior pelvic wall in a median plane at the level of the plane of the pelvic inlet is evidently too great; the posterior pelvic wall now consists at this place of the body of the fifth lumbar vertebra + the body of the first sacral vertebra, the posterior arch, and the spine of the fifth lumbar vertebra, a diagnostic mark on the value and mensuration of which, by means of subtracting the direct thickness of the posterior pelvic wall at this part from the length of the external conjugate diameter, and so getting the length of the false conjugate, I have already written in my earliest work and elsewhere.* We have, finally, the assistance of the characteristic condition of the solid angle of Breisky, as well as the circumstance that to reach the lateral parts of the anterior superior margin of the base of the sacrum one must on each side pass one's finger upwards along the posterior pelvic wall above the depressed body of the fifth lumbar vertebra. The history of the case, its course and symptoms, the progress of the development of the existing deformity, the attitude of the body, &c, all give additional support to the clinical presumptive diagnosis, every objection to which may in the face of these circumstances be considered removed, as indeed Herr Schroder himself considered. Mrs. F. had stated that she found relief if she supported * Zur Entwickelungeschichte des Spondylolisthetischen BecJcen's u.s.w., S. 36, ff. A further peculiarity of the spondylolisthetic pelvis is found theoretic.illy and practically in the position of the lumbar vertebra? (especially of the fifth lumbar vertebra) in front of the first sacral vertebra. The increase in the direct thickness of the posterior pelvic wall at the level of the base of the sacrum which this causes, leaves a striking difference between Baudeloque's diameter and the conjugata pseudo- vera, &c.; and S. 37, If in certain cases we were able to measure with instru- ments the thickness of the posterior pelvic wall, the estimation of the conjugata spuria from Baudeloque's diameter would (sic) be possible, et sequent.