Page:Clinical Lectures on the Diseases of Women.djvu/30

 jecting swelling of the base of the sacrum externally, and more on the left than on the right side. The uterus is elevated above the brim of the pelvis, 'and is three inches in the length of its cavity. She was found to be not pregnant, and was dismissed..

You will observe this case was not measured by callipers, because measurement by callipers could afford us no infor- mation — the woman had no deformity to be detected in that way ; and besides, the external tumour would render any measurement by callipers useless. The fingers here made the measurement : they measured the available conjugata vera actually and at once, and they found it one inch and a half at the time of her coming into the hospital. Here the measurement of the conjugata diagonalis was not attempted, not required, and it could scarcely have been done. This woman's disease began before the third pregnancy, in which she was delivered by craniotomy, after having had her former children easily enough. The disease was gradually increasing ; and now, if she were falling in the family way again, abortion should be induced to save her from the dangers of delivery by Caesarian section. She could not be delivered, if she went on to near full time, in any other way. In this woman, then, had we found pregnancy to exist, we should not have hesitated to destroy the pregnancy, in order to save her from the dangers attendant upon delivery of a child at or near term.

Cases of osteo-malacia are very uncommon in this country. There is a case at present in one of the medical wards. A woman may be seized with this disease after she has had some children quite easily, and may offer you a history like the history of this woman, of gradually advancing deformity of the pelvis. But in the case of osteo-malacia you would have very different conditions. The whole skeleton is modi- fied, and the woman is gradually sinking in stature as well as having her pelvis diminished in its conjugate diameter.