Page:Clinical Lectures on the Diseases of Women.djvu/29

 and you get the conjugata vera which you seek. There are a good many niceties about this measurement, but you get as your result in a healthy pelvis four inches from this plan, just as you get it from the diameter of Baude- locque.

These measurements, in the slighter class of cases, are important, but they have to be supplemented by measure- ments during labour, and by observations of the mechanism of early delivery.

Now I come to the cases. We have had recently in " Martha" four cases, not of the first or slightest class, but of the second and third.

The first case is one of which this well-known museum preparation may be held to be a representation, for in the patient, whose case I have now to read, the condition was exactly similar. The case is one of osteo-sarcoma of the sacrum ; the pelvis being neither small nor deformed, in the ordinary sense of those words ; but for obstetric purposes extremely deformed.

E. P., aged twenty-seven, married for seven years, has had four children, all born at full time ; complains of almost constant pain in the lower part of the back, greater on the left than on the right side. This pain has been present since her last confinement, seventeen months before ad- mission into the hospital. About the seventh month of her third pregnancy she first felt this pain — about three years ago. The child was delivered by craniotomy. The pain, which had been less or altogether gone, returned about the seventh month of her last or fourth pregnancy. This child was also delivered by craniotomy. Besides the pain she has leucorrhcea and frequent micturition. She has not had a monthly illness for two months, and thinks she is pregnant. She is on the whole a well-made woman. A large solid tumour occupies the posterior parts of the pelvic cavity so as to reduce the available conjugate to one inch and a half or thereabouts. There is a rounded, flattened, and slightly pro-