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The Clinical Significance of X-Ray Pelvimetry
A:VIEIU\.'A:-l" UYNEt'OLOGH'AL SO('!ETY
HERBERT THOMS, New Haven, Conn., (by invitation) read a paper (For original article ~ee page 543.)
DR.
on 'l'he Clinical Significance of X-Ray Pelvimetry. DIHCUSSIO:\'
DR. L. A. CALKINS, UNIVERSl'l'Y, VA., (by invitation) .-1 would like to ask Dr. Thoms whether he recommends this procedme as n. routine measure, or reserV('S it for those eases in which he finds some degree of contraction, and how accurate he considerg this method to be. Internal measurements of the superior strait ob tained either by pelvimetry or by haml are supposeen using it for six or seven years with considerable satisfaction. A plumb bob is hung below the x-ray tube :.md two pictures are taken, using a 10 c.. l. uhi.ft of the x-ray tube between pictures. With these pi~.tures in a stereoscopic viewing box, ink m1u-ks are ma,le so as to <·orrespond, ste1·eoseoph~ally, with the promontory, top of symphysis and all other points from whieh measurements are desired. The obstetridau ~hould eonsult the plates to assurP himself Hat these ink marks are eorredly plart'
DR. RUDOLPH W. HOLMES, CHICAGO, ILL.-This paper is a landmark in x-ray work in relation to obstetrics, however, l regret that Dr. Thoms has completed only half of the picture. He has given us a new and valuable means of determining the pelvi<· siz
600
THE AMERICAN JOURNAL 01'' OBSTETRICS AND GYNECOI"OGY
DR. IRVING STEIN, CHICAGO, ILL.-In the last five years we have studied over 730 obstetric cases roentgenographically. We feel that the clinical data are of far greater importance than the x-ray data. A little deflection of the head, a little posterior rotation of the occiput, are of more signifieance elinica.lly than nre x·ray measurements of either the head or the pelvis. The lateral pictures that Dr. Thoms showed are of exceedingly great value. I think we thus learn a great deal more about the sacrum and its form than we can ascertain by palpation; we have come to use the lateral posterior more fre· quently than formerly. I disagree with Dr. Holmes concerning the corona. If the patient is radiographed in antero-posterior the head shadow will be exaggerated so as to apparently com· pletely overlap the pelvis. A film taken in the postero-anterior will show less distortion. You can learn more by palpation and trying to force the head in from above than you can tell from the roentgenogram in these eases. The difference in the size of the fetus on the film in the two views described is often great; in the prone posture the fetus being nearer the film will give you a more accurate fetal shadow as to size whereas in the dorsal posture it will vary aceording to the Bize of the patient and the distance of t.he fetus from the film. DR. HERBERT THOMS, (closing).-Of course, I agree that in the individual case the best pelvimeter is the baby's head, but I also believe that this x-ray method has its value not only for exact mensuration of certain dimensions but cer· tainly also for the classification of contracted pelves; I do feel that it is accurate to one or two millimeters. That has been our experience in checking the method up. As a routine method I do not recommend or use it. It is simply for the case in which it is felt that more accurate knowledge of the superior strait is wanted. Lateral pictures are a great aid, particularly in the diagnosis of rickets.
K. P. FARRAR, Kew York City, presented a paper on The Reaction c;f the Tissues to Radium in Treatment of Cancer of the Cervix, and the Importance of Lacerations in Producing Oa.ncer in This Location.
DR. LILIAN
Abstract In the Woman's Hospital in the State of New York, all ward cases of cancer of the cervix \Vho have been treated with radium return for inspection once each month over a period of five years or longer if they can be persuaded to do llO. The reaction in the cervix to radium treatment is so nearly uniform that we believe we know what the appearance of the cervix will be each month if the case is progressing favorably; and that we can tell when the expected effect of radium has not been reached and a subsequent dose is needed. In order that we might fully appreciate the changes taking place in the cervix after irradiation the medical artist has attended the follow-up clinic each week and made a series of sketches in water color of individual cases beginning before the patient has received radium treatment and then sketching the cervix at each successive visit to the clinic. The visits to the clinic are sufficiently far apart to show definite stages in the progress made by radium treatment. L A Stage of Hyperemia. One week after the initial dose of radium has been given the tissues of the cervix, including of course the carcinoma and the adjacent mucosa of the vagina, are intensely red and hyperemic. The blood vessels are engorged with blood and it is for this reason that we do not consider that a ease should be radiated if an immediate operation is imperative.
HERBERT THOMS, New Haven, Conn., (by invitation) read a paper (For original article ~ee page 543.)
DR.
on 'l'he Clinical Significance of X-Ray Pelvimetry. DIHCUSSIO:\'
DR. L. A. CALKINS, UNIVERSl'l'Y, VA., (by invitation) .-1 would like to ask Dr. Thoms whether he recommends this procedme as n. routine measure, or reserV('S it for those eases in which he finds some degree of contraction, and how accurate he considerg this method to be. Internal measurements of the superior strait ob tained either by pelvimetry or by haml are suppose
DR. RUDOLPH W. HOLMES, CHICAGO, ILL.-This paper is a landmark in x-ray work in relation to obstetrics, however, l regret that Dr. Thoms has completed only half of the picture. He has given us a new and valuable means of determining the pelvi<· siz
600
THE AMERICAN JOURNAL 01'' OBSTETRICS AND GYNECOI"OGY
DR. IRVING STEIN, CHICAGO, ILL.-In the last five years we have studied over 730 obstetric cases roentgenographically. We feel that the clinical data are of far greater importance than the x-ray data. A little deflection of the head, a little posterior rotation of the occiput, are of more signifieance elinica.lly than nre x·ray measurements of either the head or the pelvis. The lateral pictures that Dr. Thoms showed are of exceedingly great value. I think we thus learn a great deal more about the sacrum and its form than we can ascertain by palpation; we have come to use the lateral posterior more fre· quently than formerly. I disagree with Dr. Holmes concerning the corona. If the patient is radiographed in antero-posterior the head shadow will be exaggerated so as to apparently com· pletely overlap the pelvis. A film taken in the postero-anterior will show less distortion. You can learn more by palpation and trying to force the head in from above than you can tell from the roentgenogram in these eases. The difference in the size of the fetus on the film in the two views described is often great; in the prone posture the fetus being nearer the film will give you a more accurate fetal shadow as to size whereas in the dorsal posture it will vary aceording to the Bize of the patient and the distance of t.he fetus from the film. DR. HERBERT THOMS, (closing).-Of course, I agree that in the individual case the best pelvimeter is the baby's head, but I also believe that this x-ray method has its value not only for exact mensuration of certain dimensions but cer· tainly also for the classification of contracted pelves; I do feel that it is accurate to one or two millimeters. That has been our experience in checking the method up. As a routine method I do not recommend or use it. It is simply for the case in which it is felt that more accurate knowledge of the superior strait is wanted. Lateral pictures are a great aid, particularly in the diagnosis of rickets.
K. P. FARRAR, Kew York City, presented a paper on The Reaction c;f the Tissues to Radium in Treatment of Cancer of the Cervix, and the Importance of Lacerations in Producing Oa.ncer in This Location.
DR. LILIAN
Abstract In the Woman's Hospital in the State of New York, all ward cases of cancer of the cervix \Vho have been treated with radium return for inspection once each month over a period of five years or longer if they can be persuaded to do llO. The reaction in the cervix to radium treatment is so nearly uniform that we believe we know what the appearance of the cervix will be each month if the case is progressing favorably; and that we can tell when the expected effect of radium has not been reached and a subsequent dose is needed. In order that we might fully appreciate the changes taking place in the cervix after irradiation the medical artist has attended the follow-up clinic each week and made a series of sketches in water color of individual cases beginning before the patient has received radium treatment and then sketching the cervix at each successive visit to the clinic. The visits to the clinic are sufficiently far apart to show definite stages in the progress made by radium treatment. L A Stage of Hyperemia. One week after the initial dose of radium has been given the tissues of the cervix, including of course the carcinoma and the adjacent mucosa of the vagina, are intensely red and hyperemic. The blood vessels are engorged with blood and it is for this reason that we do not consider that a ease should be radiated if an immediate operation is imperative.