186 



PELVIS. 



inches; the left, f of an inch only. The 

 transverse diameter, measured in the lateral 

 curve of the brim, 6^ inches. At the inferior 

 outlet, the antero-posterior, 4 inches ; the 

 transverse, 5. In the figure of this pelvis 

 given by the author, the long axis of the 

 sacrum is represented as placed obliquely 

 across the median line, its apex inclining to 

 the right side; while the tuberosity of the 

 right ischium is widely divergent, principally 

 causing the increase of the transverse dia- 

 meter of the outlet. The left ischial tube- 

 rosity and acetabulum are brought more 

 under the line of gravity. The left superior 

 pubic ram us is thus pushed nearer to the 

 promontory than the right, causing a slight 

 twist in the pubic symphysis. In this pelvis 

 the author considers that delivery might be 

 effected " per vias naturales," by craniotomy. 



In one of Dr. Hull's cases, that of Ann 

 Lee, affected with this deformity, the con- 

 jugate diameter was reduced to 1-| inch, 

 and the sacro-cotyloid on each side equal, 

 and measuring l^g- inch. The transverse 

 diameter, in its widest part, amounted to 4^ 

 inches only. There was little flattening of 

 the pubes, the contraction being produced 

 chiefly by the projection of the sacrum, the 

 chief bend being near the sacro-iliac joints. 

 The distance between the antero-superior 

 iliac spines was only 8^ inches, but the dimen- 

 sions of the cavity and inferior outlet were not 

 materially diminished. 



In Mr. Thomson's case of Caesarian section, 

 the pelvis was affected with this deformity. 

 The normal lumbar curvature was so much 

 increased, together with the pelvic inclination, 

 that the sacrum was placed quite horizontal, 

 and the superior plane directly vertical, and 

 its axis consequently parallel with the hori- 

 zon; but with little or no lateral deviation 

 of the sacral promontory. The legs were 

 crooked, and the acetabula faced directly 

 forwards. The conjugate diameter of the 

 brim was diminished to $ of an inch ; the 

 transverse was about 5 inches, and the inter- 

 sciatic apparently about 4.* 



Dr. Robert Lee gives the dimensions of a 

 case of ovate deformity in which the patient, 

 after being delivered by craniotomy at an 

 early period of pregnancy in the first labour, 

 died in the second from rupture of the uterus. 

 The conjugate diameter of the brim was 2 

 inches 1 line; the transverse, 5f inches. At 

 the outlet the distance between the sciatic 

 tuberosities was 4 inches ; between the tip 

 of the coccyx and lower border of the pubic 

 symphysis, Si inches. This obstetrician con- 

 siders that if, in this case, premature labour 

 had been induced at or before the fifth, in- 

 stead of the seventh month, the patient might 

 have been saved.f 



It has been said that in pelves presenting 

 the ovate deformity from rickets, the contrac- 

 tions of the diameters of the brim are generally 



* Med. Observations and Inquiry, vol. iv., with 

 plates. 



f Lectures in Med. Gazette, 1843, p. 181. 



accompanied by the enlargement of those of 

 the outlet, and the numerous examples of 

 enlarged transverse diameters of the outlet, 

 in particular, are adduced. 



In an ovately deformed pel vis in the Museum 

 of King's College, however, in which the con- 

 jugate diameter of the brim is 2 inches, and the 

 transverse also contracted to 4f inches ; at the 

 outlet the inter-sciatic diameter is contracted 

 to as little as 3| inches, and with it the sub- 

 pubic angle is diminished also, while the 

 antero-posterior is increased to 4 inches. 

 This pelvis is remarkable for the great flat- 

 tening of the sacrum, the anterior surface of 

 which lies almost in a straight line, in which 

 direction the coccyx also is nearly placed. 

 The antero-posterior diameter of the cavity 

 is thus reduced to 3 inches. The distance 

 between the ischiai spines is, however, 4> 

 inches. The sacral promontory projects more 

 forwards than downwards, and the lumbar 

 curve is inclined to the left side. In this 

 pelvis the brim is contracted considerably in 

 all its diameters, and this contraction is 

 evidently produced by the crushing down- 

 wards of the sides of the cotylo-sacral arch. 

 The length of the cotylo-sacral rib on the 

 right side, taken from opposite the ilio-pec- 

 tineal eminence to the sacro-iliac angle along 

 the curve, amounts to only ]i inch, while the 

 direct measurement is reduced to 1 inch. 

 The rib of bone is at the same time much 

 increased in thickness, presenting an almost 

 cubical mass between the cotyloid and sacro- 

 iliac articulations. On the left side, the direct 

 measurement is a little more. 



In the table of measurements of diseased 

 pelves given by Dr. Murphy, the transverse 

 diameter of the brim in the five ovate pelves 

 amounts to 5 inches only in two cases, and 

 in a third, it is diminished to 4f inches. In 

 many of these cases we may conclude that 

 the cotylo-sacral rib was shortened as well as 

 bent backward. The transverse diameter of 

 the inferior opening is not enlarged in all the 

 above-mentioned cases. In one it amounted 

 only to 3f, and the sub-pubic angle (mainly 

 depending on this diameter) is only 70. 

 The antero-posterior diameter is, in* three 

 cases, increased to from 4 to 4| inches, while 

 in the remaining two cases it is diminished 

 to 2% and 2-J. These latter measurements, 

 doubtless, depend in great measure upon the 

 position of the coccyx, or, as in the case 

 above given from the Museum of King's Col- 

 lege, upon the flatness of the sacrum, or in 

 its bend. They show, however, that the en- 

 largement of the inferior diameters in not uni- 

 versally characteristic of the general ovate 

 deformity. We may also conclude that the 

 general contraction of the diameters of the 

 brim, which is often found in these pelves, is 

 produced mainly by the shortening of the 

 col^lo-sacral rib of the ilium in the line of 

 pressure, without any aversion of the lower 

 part of the innominate bones. 



A singular pelvic deformity, related in 

 some degree to this class, is represented in 

 Moreau's plates, in which, by an anterior 



