Page:Clinical Lectures on the Diseases of Women.djvu/26

16 it. Upon this third class I shall say nothing more meantime.

Now I come back to the first set of cases, which are far the most important—the slightest class of mechanically difficult labours. The astonishing result has been clinically arrived at, that in Germany there is a mass of from 12 to 15 per cent. of such cases. I am quite sure that there will be found much fewer in this country. That is a judgment, not a statement founded upon exact information, because I know no hospital or practice in this country where there has been systematic measurement of every case and observation of the mechanism of early labour, with a view to decide such a question; but it is founded upon this, which is almost positive proof, that in this country malpresentations, cord presentations, face presentations, are rarer than in Germany. I should be very much astonished, therefore, if a careful clinical inquiry resulted in showing that in this country there were so many as from 12 to 15 per cent. of pelves abnormal, as has been found by thoroughly competent authorities in Germany.

In these slightest cases, pelvimetry is most difficult. The pelvimetry in these cases consists in very simple measurements, which, however, you require to learn to make. A practitioner is very awkward in making such measurements at first, and he requires to have a good callipers or other good external pelvimeter. He requires experience, still more, for internal pelvimetry.

How do you proceed in these cases? The patient is undressed, and placed on a suitable bed for examination. The object is to find out as nearly as you can the length of the conjugata vera, and to find out the general size of the pelvis. In all cases these are the two chief things; but in cases of higher deformity you go farther, and measure such things as the distances of the posterior superior spines of the ilia, and make a variety of further observations which I do not enter upon now.