Frequency, etiology and practical significance of contractions of the pelvic outlet / by J. Whitridge Williams.

  • Williams, J. Whitridge (John Whitridge), 1866-1931.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Frequency, etiology and practical significance of contractions of the pelvic outlet / 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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    tracted variety, as is shown by the following table: Transverse of outlet 8 cm. 7-5 cm. 7 cm. 5-5 cm. Total Typical funnel pelvis. .. 50 (60.2%) (26282%) 10 (12%) (1%) 83 Generally contracted fun- 24 6 4 O nel pelvis (70.6%) (17 -7%) (n-7%) (0%) 34 Upon comparing the findings in the two races it is noted that the incidence of the typical funnel pelvis is approximately identical in both; while the generally contracted variety occurs four times more frequently in colored women, as is clearly shown by the following figures: 49 typical funnel pelves in 670 whites 7.32% 34 typical funnel pelves in 670 whites 34 typical funnel pelves in 530 blacks 6.42% A ratio of 10 to 9. 8 generally contracted funnel pelves in 670 whites 1.19% 26 generally contracted funnel pelves in 530 blacks 4.91% A ratio of To to 42. This latter observation is of more than sta- tistical interest, and will be utilized later to justify the distinction between the two types of funnel pelves, as well as to support the con- tention that they are dependent upon radically different etiological factions. Etiology. Up to comparatively recently the views advanced concerning the mode of pro- duction of funnel pelves were very vague and unsatisfactory, and although Breus and Ko- lisko had made important contributions in this regard, their teachings have not received general acceptance. Thus, Schroeder stated that but little was known concerning the abnormality, and held that it should be regarded as a manifestation of imperfect development, particularly when the advance of the tip of the sacrum was asso- ciated with retrocession of the promontory. In other instances he was inclined to believe that the abnormality should be attributed to a kyphosis which had escaped recognition. Spiegelberg, likewise, taught that the etiology was uncertain, although he felt that the prime factor should be sought in faulty or imperfect development of the alae of the sacrum. At the same time, he considered that the dimin- ished inclination of the sacrum probably indicated that the transformation from the foetal to the adult form of pelvis had not been entirely completed. Schauta held that the condition should be attributed to some abnormality in development which had led to increased depth of the pelvic cavity. Under such circumstances the prom- ontory of the sacrum would necessarily occupy a higher and more posterior position than usual, so that, when exposed to the action of the body weight, the entire sacrum would rotate in such a manner that its promontory would become retropulsed, while its tip ap- proached the symphysis, just as happens to a more marked degree in typical kyphotic pelves. Fleischman, Bulius, Emminghaus and Rich- ter were likewise very uncertain in their views, but were inclined to attribute the deformity to defective development, which was mani- fested by the infantile or masculine character of the entire pelvis later in life. In 1900, Breus and Koliske, in the first sec- tion of their work upon deformed pelves, made a distinct contribution to our knowledge, in that they directed attention to the surprising frequency of lumbo-sacral assimilation. When the last lumbar vertebra becomes assimilated to the sacrum, they held that a pelves results in which the sacrum is made up of six vertebrae and whose promontory occupies a much higher position than usual. This they designated as high assimilation, and pointed out that such a pelvis may assume one of two forms. In the first, owing to the greater height and lesser width of the sacral alae, its entire cavity may become narrowed transversely, although the contraction is usually more marked at the superior strait, which consequently assumes a more rounded shape. In the second variety on the other hand, the alae retain their usual width, but the sacrum rotates in such a manner that its promontory becomes displaced back- ward and its tip forward, with the result that the antero-posterior diameter of the superior strait becomes lengthened while that of the inferior strait is shortened. At the same time, owing to the change in position of the sacro-