Is pubiotomy a justifiable operation? : [second communication based upon a series of twenty-five successful cases] / by J. Whitridge Williams.

  • John Whitridge Williams
Date:
1910
Catalogue details

Licence: In copyright

Credit: Is pubiotomy a justifiable operation? : [second communication based upon a series of twenty-five successful cases] / by J. Whitridge Williams. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    children were saved, and it may be added that the death of only one of the latter could be attributed to the operation; namely, case V of the previous series. On analyzing the histories of the twenty-five operations, one finds that twelve of the patients were primiparous and thirteen multiparous, while nine were white and sixteen black. More- over, the accompanying table shows the incidence of the several varieties of contracted pelvis and their partition between the two races. Type of pelvis Generally contracted rhachitic. Generally contracted funnel. Generally contracted Simple flat Flat rhachitic Typical funnel Total In 9 white In 16 black number women women 14 2 12 3 .3 1 1 1 3 3 | 2 2 2 2 . 25 9 16 It thus appears that rhachitic pelves were noted in only two of the nine white patients, as compared with fourteen of the six- teen black patients, an incidence of 22 and 75 per cent, respect- ively. In twenty cases presenting the usual types of pelvic deformity the conjugata vera varied from 7 to 8.75 cm.; whereas in the five generally contracted and typical funnel pelves the distance between the tubera ischii measured 7 to 7.75 cm. In the entire series there were one transverse, four breech, and twenty vertex presentations. In the latter category the posi- tions noted were as follows: L. O. A., three; L. O. T., six; R. O. T., six; and R. O. P., five; thus indicating that in 55 per cent, of the cases the occiput was directed toward the right side. More- over, the fact that anterior positions were noted in only 15 per cent, of the cases clearly emphasizes the effect of the pelvic abnormality upon the position of the head. Ordinarily the operation was not undertaken until a long test of the second stage had demonstrated that nature was unable to overcome the disproportion between the size of the head and the pelvis, its average duration being three and one-half hours. In five cases, on the other hand, interference was effected earlier. Thus, in case XXI, in which the child presented transversely, the operation was undertaken one hour after complete dilata-