Page:Clinical Lectures on the Diseases of Women.djvu/35

 Now, finally, suppose you have had a case of this kind. The future treatment of the woman is easier, because in future pregnancies you have the history of the labour in the former pregnancy to aid you. And every woman who has a deformed pelvis should have kept for her a careful record of the history of her various deliveries, so that the practitioner may have the instruction derivable from former deliveries.

Every woman whom you deliver, who has a pelvis that is at all suspected of contraction, should have five different measurements of her brim, for the purpose of guiding the treatment in subsequent confinements.

Firstly, you have the measurement of the conjugata vera founded upon the measurement of the diameter of Baude- locque — the external measurement ; and that you can get at any time. Secondly, you have the measurement of the conjugata vera founded upon the measurement of the con- jugata diagonalis ; and that measurement you can fre- quently get at any time, whether the woman is pregnant or not. The third measurement is a measurement that we can only get when the woman is not in a state of advanced pregnancy ; it is a measurement which is easily made in a thin woman — a woman who has not much fat in the anterior abdominal wall, nor any kind of abdominal dis- tension. You can make out in such a woman through the anterior abdominal flap the promontory of the sacrum and the symphysis pubis, and measure the intervening distance. Then you have a fourth measurement, which generally can be made, and is made, only during delivery, or immediately after it. I told you that in a slightly contracted pelvis you cannot actually measure the conjugata vera before delivery as you can measure it in an extremely contracted one by jamming the fingers into it ; but immediately after delivery it is your duty to do that, and you do it by intro- ducing your whole hand into the pelvis. Every practitioner