PELVIS. 



193 



From the anterior inferior iliac spine, to the 

 opposite point on the iliac crest posteriorly 

 on the left side, 2 inches 4 lines ; on the 

 right side, 2 inches 6 lines. From the apex to 

 the upper surface of the sacrum, 16 lines only ; 

 to the junction of the 1st and 2nd sacral pieces, 

 1 Oi lines. From the left superior pubic ramus a 

 little internal to the pectineal eminence, to the 

 body of the 4th lumbar vertebra on the same 

 level, only 2i lines. Between the same points 

 on the right side, 6 lines. The sides of the 

 sub -pubic arch were only 3 lines apart, and 

 more contracted near the sciatic tuberosities 

 than above, by these processes being pushed 

 inwards. The pubes in this pelvis, as repre- 

 sented in the drawings given by the author, 

 are bent in the middle of their superior rami, 

 thus producing the rostrated form. 



A like case of progressive pelvic deformity 

 from mollities ossium is described by Dr. 

 Cooper.* The patient. Elizabeth Foster, 

 had perfectly easy delivery in her three first 

 labours ; before the fourth, she had, while 

 pregnant, rheumatic fever, and afterwards 

 constantly suffered from universal pains of a 

 rheumatic character, followed by gradual spinal 

 distortion. From the fourth to the sixth labours, 

 they were increasingly difficult, and in the se- 

 venth and eighth she was obliged to be delivered 

 by craniotomy, the sacro-pubic diameter being 

 reduced to 2 inches. Three years after, she 

 again became pregnant, when the sacro-pubic 

 diameter was found to be reduced to 1^ inch, 

 becoming gradually narrower on each side. 

 Caesarian section was performed, under which 

 she sank. After death, the sub-pubic arch 

 was found to be so much contracted, that the 

 sciatic rami were little more than an inch 

 apart. The pelvis was so soft and spongy, 

 that the finger could be easily pressed into its 

 substance, and at the place of attachment of 

 some of the muscles, the osseous substance 

 was found raised into eminences, as if pulled 

 out. 



Eight similar progressive cases were ob- 

 served by Barlow. One woman, on whom 

 he performed hysterotomy unsuccessfully, had 

 given birth to two children, and afterwards 

 had become lame and bed-ridden for four 

 years. In another case of Caesarian section, 

 also resulting from malacosteon, the woman 

 had previously borne children, and been deli- 

 vered by the crotchet. In this instance, the 

 conjugate diameter was reduced to ]i inch ; 

 the right sacro-cotyloid, to 2 ; the left, to 

 ] inch. The last lumbar vertebra and sa- 

 cral promontory formed a great tumour-like 

 curve in the pelvic cavity, which he was able 

 to distinguish from an exostosis only by its 

 yielding easily to the pressure of the fingers, 

 which a tumour of that nature would not do.f 

 Other cases of this progressive kind have been 

 before alluded to. 



The question as to whether the rickety 

 pelvis ever assumes the angular or cordifonn 

 shape, is one which has occupied consider- 

 ably the attention of many obstetricians. 



* Med. Observations and Inquiries, vol. v. 

 t Essays, p. 355. 

 Supp. 



It was very ingeniously advocated by Dr. 

 Hull in his Letters to Symmonds, and laid 

 down by the younger Stein and others on the 

 Continent, that the ovate form of pelvic dis- 

 tortion with contraction of the diameters of 

 the inlet and enlargement of those of the 

 outlet of the pelvis, was the characteristic 

 and invariable form of rickety disease; as 

 that of the angular cordiform shape, with 

 contraction of both outlets, was of malacosteon; 

 and the opinion seems to be still frequently 

 held by obstetricians both abroad and in this 

 country. 



Dr. Murphy considers that, though the oval 

 pelvis is not the necessary consequence of 

 rickets, nor the cordiform of mollities ossium, 

 yet that " of necessity, the softened adult pel- 

 vis would take the shape called cordiform, 

 while the infant pelvis would be transversely 

 lengthened;" unless in the infant, "the 

 spine be softened and bent as well as the 

 pelvis," so as to throw the weight of the body 

 more upon the pelvic cavity, as by a " backward 

 curvature " such as he has figured, in which 

 cases he supposes that angular deformity takes 

 place in the child.* This conclusion he draws 

 from the hypothesis that in the child, because 

 of the straightness of the spine, a line passing 

 through the centre of gravity, and conse- 

 quently the weight of the spine, would fall 

 altogether I'M advance of the pelvic cavity, and 

 that consequently the acetabula would be 

 pressed up behind it, and of necessity, diverge, 

 because of the sacrum pressing down between 

 them ; while, in the adult, the weight of the 

 body falls within the pelvis and between the 

 acetabula, which consequently would be 

 pressed inwards towards it. In considering 

 the mechanism of these pelvic deformities we 

 shall again have occasion to refer to this ex- 

 planation. But this author also thinks that 

 a condition of bones identical with or allied 

 to rickets, may be induced in young adult 

 females, whose health is depreciated, and 

 powers of nutrition impaired, by the con- 

 fined or unhealthy nature of their employ- 

 ment ; and that there is thus constituted a 

 special kind of mollities ossium, a rickets of 

 adults, in which cases the pelvis will assume 

 the cordiform shape. The frequent occurrence 

 of spinal deformities at this age, is an evidence 

 of a deficiency in the supply of osseous mate- 

 rial. 



Naegele, who warmly combats the opinion 

 that the infant rickety pelvis is always ellip- 

 tical, quotes in support of his arguments 

 against it, a case attended by Dr. J. A. 

 Beyerle and Professor Fischer, of Mannheim. 

 The history of the case, and the appearance 

 of the patient herself, and of her father, 

 brothers, and sister, indicated scrofula and 

 extensive rickety deformity existing in the 

 family. The patient had been deformed from 

 the earliest youth, and had not attempted to 

 walk or stand till she was seven years old. 

 She was of very small stature, 4 feet 3 

 inches, had a projecting sternum, an awk- 

 ward, shambling, waddling gait, and a remark- 

 * Lectures on Parturition, p. 32. 



