Frequency, etiology and practical significance of contractions of the pelvic outlet / by J. Whitridge Williams.

  • Williams, J. Whitridge (John Whitridge), 1866-1931.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Frequency, etiology and practical significance of contractions of the pelvic outlet / 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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    *3 sary only in the last-named condition; but in hospital work it is advisable to make the ac- curate determination of the length of the various diameters an integral part of the routine pelvimetry. Various methods have been suggested for determining the length of the transverse diame- ter. Thus, Breisky in 1870 palpated the most widely distant portions of the inner surface of the tubera ischii, and, after determining the distance between them by means of a pelvi- meter, made a deduction of one half to two centimeters according to the thickness of the overlying soft parts. He admitted the theoreti- cal objections to such a procedure, but never- theless claimed that it gave fairly accurate results. Schroeder suggested palpating the tubera ischii, marking their outlines with a dermatographic pencil, and then measuring the greatest distance between the lines. In my experience, however, this method is even less accurate than that of Breisky, for the reason that the position of the lines must change to some extent as soon as the pressure of the palpating fingers is relieved. Frankenhauser in 1879 believed that the disadvantages of both these methods could be overcome if after palpating the most widely distant portions of the tubera, the thumb nails were placed in such a position as to represent the continuation of the inner surface of the ischial bones, and the distance between them measured directly with a pelvimeter (Fig. 2).. This method was employed in our series of cases and has apparently given fairly accurate results. Unfortunately, it is not available for the ordinary practitioner as it requires the services of an assistant to manipulate the pelvi- meter. In order to overcome this objection I have advised a very light pelvimeter with broad, flat ends, which can be attached to the thumbs by means of adjustable rings (Fig. 3). After palpating the tubera by Franken- hauser’s method, the flat ends of the instru- ment are brought into apposition with the thumb nails, and the distance between them read directly from the scale. As the results obtained by its means are identical with those furnished by the original method of Franken- hauser, I believe that the device may serve a useful purpose. The length of the antero-posterior diameter of the outlet is obtained, as recommended by Breisky, by measuring the distance between the lower margin- of the symphysis and the pos- terior surface of the tip of the sacrum, and afterwards deducting one or one and a half centimeters according to the thickness of the intervening bone. While making this meas- urement Breisky placed the patient upon her side, but I have found that equally satisfac- tory results may be obtained, with far less trouble, by having the patient upon her back with the buttocks protruding a short distance beyond the edge of the table and using a pelvi- meter whose blades are only slightly curved (Fig- 4)- Whenever the transverse diameter measures 8 cm. or less, or the antero-posterior 9 cm., a diagnosis of funnel pelvis should be made, while the determination of the special type will depend upon the other pelvic measure- ments. The typical, or generally contracted funnel pelvis being diagnosticated according as the usual external measurements and the diagonal conjugate are normal or shortened. Unfortunately, as has already been indicated, such a diagnosis gives no information as to the probable outcome of labor, so that when- ever the transverse or antero-posterior diame- ters are shortened it becomes necessary to determine the length of the anterior and pos- terior sagittal diameters. This can be accomplished without great difficulty by means of the pelvimeter invented by Klien, or by a modification which I have devised. The latter consists of a longer curved and a shorter straight blade and a horizontal bar. The latter is 5 cm. long and is so shaped that it can be conveniently held in position by two fingers of an assistant. To its center what would ordinarily be the free end of the shorter blade is attached in such a way as to permit free rotation in a vertical direction. Moreover, the lower part of this blade is made up of two portions, which are so articulated with one another as to permit the upper to rotate freely in a lateral sense upon the lower portion, which in turn can rotate vertically, but not laterally, upon the horizontal bar. As a result of this mechanism, it follows that the tip of the curved blade of