A NEW OUTLOOK IN CARDIOLOGY
BMJ (Clinical Research Edition)
of an eclamptic case delivered by-myself and, one other delivered by one of my assistanits, these lacerations werd all tlle result of deliv-ery of breech cases with extended armns, or in easy forceps .ceses wlheie stiidgits wele allowed to perform the delivery. So miiuch for my ow-n persoiial statistics, frolmi which-I have drawn my conclusions. Dr. Bell refers to Professor WNliitridge Willialis's typical funniel-shaped pelvis, and says the only observation not conifirmuedI is tlie causal
... s tlie causal factor. It seems to me extraordiinaiy that in WN'illiams's first edition funniiel-slhaped pelvis slhouil(d only be conisidered as the result of, or an associated coniditioni of, malrkcd kyphotic pelvis in spite of the enolrmolus l)iealevince of the condition-6.1 per cent., as stated in the 1£20 editioll. It is also stated thlat formerly this type of pelvis was looked upon as a masculine oIr infanitile type, but Williams now looks upon it as in the npajority of cases due to high assimila-. tioii-namiiely, six sacral vertebrae. I wonder if Dr. Bell can confirm the enormous frequeincy of this anatomical fault. The shortening is said to be limited to the transverse diameter of tlle outlet in the miiajority of cases; ordinarily the reduction' is to 7 or 8 centimetres, occasionally less. It is also p)oinlted out that with the patient' in ail 'exaggerated S'ims's position ani average inierease of 0.75 cm. ocCIIurs in the posterior sagittal diameter with extremes of 0 to 4 cm.,; witlh such-pliability of the pelvic bones (whichl by the way I do niot thilnk exists) tlle shortness of the diallieter canl be comipensated in all buit tlho occasional cases rieduce(d under the ordiniary amIount. If this movement of the p)elv-ic bonies occurs, the measurements obtained in the dorsal position do not show the maximum space available, aiid possibly tho relative freedom from lacerationi whlicll I lhave experienced is due to the p)ractice of applying forceps in the left lateral position. Contraction of tlie outlet antero-posteriorly is said to occur in rare instanices, anid is usually associated with flattening of the tllper strait. I adlmit that, but such a case is one of flat, ilot ftuinnel-slhaped, pelvis. The most tvpical examples are said to ocCuIr in the kvpotic and spondylolisthetic pelvis; the latter is al special alnd very rare type of pelvis in practice, anid is excluded in the rlass; in my opinion the formertype is al-so a relatively rare type, and should niot be classed as fuiinnel-shaped when that is by the far the least feature of the deformity. It is initeresting to take W illiams's statistics of cases seriously affected in labour; in 135 cases the following operationis were necessary: forcep.s 17, Caesarean section 1, pubiotomy 3, craniotomiiy 1. rThej ilcidence of forceps is 12.6 per cent., wlhich compares with a total incidenice in Queen Charlotte's Hospital for -the year 1920 of .13.8 per cent.. It w-ould be interestinig to know whether the five other cases were of simiiple funniel-shlaped pelvis or associated with kvphosis or someother condition. Dr. Bell considers his patient would niot lhave lhad a living. child if she had been delivered thlrougl the pelvis; I should be mllore disposed to agree if lie had-Ihimself delivered the first infant, but from my experienice of cases described as incapable of pel-ic delivery and for that reason sent to hospital, I do notaccept the statement as conclusive.