178 



PELVIS. 



Translation ; Osteologie and Syndesmologie, par 

 M. Scemmerring; Mechauique des Organes de la Lo- 

 comotion, par G. and/?. Weber, vol. ii. Developpe- 

 ment de 1'Homme et des Mammiferes, par Bischnff, 

 vol. viii. Borello, de Motu Animalium. Weber, 

 W. and E., Mechanik der Menschlichen Ge.hwevk- 

 zeuge, Gb'ttingen, 1836. Memoirs de Plnstitute, 

 torn, vi., 1806. Tenon, Memoir sur les Os du Bassin 

 de la Femme, p. 149. Sandiforc, De Pelve ejus in 

 partu dilatatione. Naegele, Des principaux Vices de 

 Conformation du Bassin, traduit par Danyan, Paris, 

 1840. Das weibliche Becken, Carlsruhe, 1825. 

 Dr. W. Hunter, on the Symphysis Pubis, London 

 Medical Observer and Inquirer, vol. ii., No. 28. 

 Levret, 1'Art des Accouchments, Paris, 1753. 

 Boivin, Madame, Memoir de 1'Art des Accouchments. 

 Murphy, Lectures on Parturition, 1845. Rams- 

 lotham, Obstetric Medicine and Surgery. Churchill, 

 Theory and Practice of Midwifery, 1842. Rudiments 

 of Civil Engineering, by H. Law, Civ. Eng. 

 Grants Outlines of Comparative Anatomy. Cams, 

 Introduction to Comparative Anatomy, by Gore. 

 Wagner's Elements of Comparative Anatomy, by 

 Tulk, 1845. CV/r/e/'s Ossements Fossils; Regne 

 Animal ; Lecons d'Anatom. Comp. Owen's Hunte- 

 rian Lectures, vol. ii. ; Homology of the Vertebrate 

 Skeleton ; Osteography of Pitheci, and Anatomy of 

 Apieryx and Mylodon in the Transactions of the 

 Zoological Society, vol. i. and ii. Blalnvliles Oste- 

 ographie Comparse. Knox, in Lancet, 1839-40, 

 and 'in Medical Gazette, 1843. Often' s Physico- 

 Philosophy by Tulk. Carlyk, Report of British 

 Association. 1837, p. 112. JDuges, Recherches sur 

 Jes Batraciens. Paris. 1835. Le Gallois, Experiences 

 sur la ^Vie (Appendix). Priichartfs Physical His- 

 tory of Mankind, 1836, 3rd ed. 



PELVIS, ABNORMAL ANATOMY OF THE. 

 From the close relation of this structure to 

 the processes of child-bearing, the most im- 

 portant of the alterations to which it is liable 

 by disease, are such as produce deformity and 

 obstruction of the passages, and occurring in the 

 female subject. In the experience of Dr. 

 Robert Lee, about one-sixth of all the cases 

 of difficult parturition in London, depend 

 upon contraction of the pelvis from arrest of 

 development or distortion. In the male sub- 

 ject, they are interesting mainly as to the %ht 

 they may throw upon the processes and me- 

 chanisms of the abnormal changes. 



On reviewing a good collection of abnor- 

 mal pelves, we find them susceptible of the 

 following classification, of which the prin- 

 cipal part are interesting chiefly to the obste- 

 trician, but, in a great degree, to the surgeon 

 and general pathologist also. 



PELVIC DEFORMITIES AND OBSTRUCTIONS. 

 Deformities of the pelvis, properly so called, 

 are all such departures from the adult "stan- 

 dard," in size, build, and conformation, as 

 are sufficiently marked to influence child- 

 bearing. 



They have been variously arranged, but 

 seem to fall best under two heads : viz. 

 ]. Normal irregularities including all those 

 which present the shape and proportions pro- 

 per to the healthy pelvis at some period of its 

 development ; and, 2. Distortions, including 

 all such peculiar alterations of shape and size 

 as are consequent upon disease or injury. 



1. Normal irregularities may be subdivided 

 into, Equable deviations, in which the general 

 form and appearance are similar, and the dia- 

 meters proportionate to those of the " standard" 

 pelvis ; and, Irregularities from imperfect de- 



velopment, in which the shape deviates from, 

 and the diameters are not in proportion to, 

 those of the " standard" 



Equable deviations, " Pelvis eqtiabiliter justo 

 major." The irregularity in this pelvis con- 

 sists in all the diameters being in excess. It 

 is not uncommon. Burns records one ex- 

 ample. Dr. Murphy has another in his pos- 

 session, and there is in the Museum of King's 

 College a third, the brim of which measures 

 6 inches transversely, by 5 inches antero- 

 posteriorly. The largest hitherto recorded is 

 one by Giles de la Tournette, who gives 



in. 



The distance between iliac crests - - 1 2 



Antero-posterior diam. of brim - 5^ 



Transverse diam. of do. - 6^ 



Both the diameters of the inferior outlet - 5^ 



The disadvantages of this pelvis are said to 

 be prolapse and displacement of the viscera, 

 sudden expulsion of the foetus, inversion of 

 the uterus, and want of the proper impress 

 of rotation on the head. Retroversion of the 

 uterus and its prolapse in the impregnated state, 

 are said by some to be most commonly ob- 

 served in large pelves. 



" Pelvis equabiliter justo minor. " In this 

 pelvis, all the diameters are proportion- 

 ately diminished. The diminution is said, by 

 Churchill, to be generally about one-fourth. 

 Naegele thinks it to be more common than had 

 been supposed by Bandelocque and other 

 writers on midwifery. Velpean gives two 

 cases of " Etroitesse absolue " (Journal Com- 

 plementaire}, in which the diminution was so 

 great that one woman died undelivered, and 

 the other underwent the Caesarian operation. 



It was considered by Alexander Shaw *, that 

 proportionable contraction of the pelvic di- 

 ameters is very common in rickety subjects, 

 from want of proper osseous development, and 

 that it is generally accompanied by correspond- 

 ing diminution of the size of the bones of the 

 lower extremities. The experience of Rokitan- 

 sky also favours the opinion that this propor- 

 tionate contraction, without distortion of the 

 pelvis, may be produced by rickets. Naegele, 

 however, records three female pelves affected 

 with this deformity, which presented no ap- 

 pearance whatever of rickety change, neither 

 in strength, weight, nor texture, one being 

 even heavier than usual ; nor were there any 

 rickety symptoms in their history. Two of 

 the subjects died after severe instrumental 

 labour ; and the third, after one miscarriage, 

 died undelivered of the second conception, 

 from rupture of the uterus; comparison with 

 the child's head afterwards showing, that de- 

 livery of a living child would have been im- 

 possible without the Caesarian section. The 

 diameters were generally above an inch less 

 than the standard measurement. The ages of 

 these subjects were from twenty-three to 

 thirty-two years, showing that the contraction 

 was an adult deformity. They were also 

 about or above the average height. Women 

 of low stature, indeed, have most commonly 

 large pelves as well as large heads, and are 

 not more liable to this deformity than those 

 * Med. Chirurg. Transactions, vol. xvii. 



