The clinical assessment of disproportion.

infection is the precipitating factor. Intramuscular penicillin, combined where indicated, with inhalation therapy should be commenced at once if chest infection is felt to be a contributory factor in cardiac breakdown. Meanwhile investigations should be started and modification of treatment may be made as indicated. The effective treatment of the lung lesion associated with the correct approach to the heart condition may lead to dramatic improvement in what may otherwise seem to be a hopeless problem. Conclusions I. Dogmatism must be avoided when considering the use of antibiotics in non-tuberculous disease of the chest. 2. Bacteriological investigation and sensitivity tests of organisms obtained are essential. 3. Blunderbuss therapy must not be used. 4. Newly discovered and comparatively untested antibiotics must not easily replace tried remedies. 5. The wider aspects of aetiology such as social factors must be evaluated. 6. The important part that lung infection plays in heart failure has been touched upon. I should like to thank my colleagues, and many others in the hospital for their constant cooperation and help with these problems. Attention has been devoted during recent years to radiological methods of assessment of the sizes of the maternal pelvis and foetal head and much has been achieved. The greatest strides have been made in the estimation of the size of the pelvis, but progress has not been limited to actual measurement of the bony structures. There is now a better understanding of the architecture of the pelvis-of its variations in shape as well as in size-and of the significance of these variations. So much thought has, in fact, been directed into these comparatively new channels that many of the methods of clinical assessment previously in use seem to have been forgotten or to have fallen largely into disuse. For this reason the time now seems opportune to reconsider some of the clinical methods available for estimating the relative sizes of the foetal head and the maternal pelvis. It is, after all, upon these methods that we must rely to select those cases which require fuller investigation and ultimately, in conjunction with other findings, to decide upon the further management of the case. The words of the pious i8th century German midwife, Justine Siegemundin-'All I do depends on God's help and on the skilful motions of my hands '-have a particular application to this type of case. Some indication of possible difficulty at the time of …