Page:Clinical Lectures on the Diseases of Women.djvu/28

18 an inch more than the former. These two measurements afford valuable evidence; they are easily taken, and you will find their value excellently illustrated in the cases I have to go over immediately. If these measurements are both small, then you have reason to suspect that the brim of the woman's pelvis is small. If the measurement (as in this case) of the crests is smaller than the measurement of the spines, or equal, then you have reason to believe that the pelvis is contracted or flattened in its antero-posterior diameter.

The next measurement is the most difficult; it is also the most important. In the graver cases no other measurement is absolutely required—that is, the measurement of the conjugata diagonalis, which is known in books as "C. d."—generally in a well-made pelvis four inches and a half. But in a full-sized pelvis it is often not to be measured during life: to do so would give the woman too much pain; you would have to force the fingers too far in order to succeed. You will see how easily it is measured in some of the cases of contraction that I shall presently describe. This measurement is made by pushing one or two fingers per vaginam so as to touch the promontory with the point of the index-finger if one is used, or of the middle finger if two are used (the index-finger being not long enough). With the nail of the index of your other hand you mark off where the inferior border of the symphysis cuts the radial side of the introduced index-finger, and then you have a pretty accurate measurement of the conjugata diagonalis by telling off the distance between the point of the index-finger if that alone was used, or between the point of the middle finger and the mark you have made with the nail of your other index upon the radial border of the hand. This gives you the conjugata diagonalis. Now, from this you argue as to what you wish to ascertain—namely, the conjugata vera ("C. v.") The conjugata diagonalis being ascertained, from this take half an inch,