194 



PELVIS. 



able projection of the abdomen, caused by a 

 great increase in the normal forward bend of 

 the lumbar curve ; with an equivalent projec- 

 tion of the sacrum posteriorly, from the hori- 

 zontal position of that bone ; so that the plane 

 of the superior pelvic opening was, in the 

 upright position, completely vertical. The 

 lower extremities were not, however, de- 

 formed, neither the bones of the upper nor 

 lower leg being bent. About the age of thirty, 

 she became pregant, and died after the neces- 

 sary performance of the Caesarian section. 



On being examined, the lumbar vertebra 

 were found much curved forwards, and small, 

 slender, and weak. The sacrum was placed 

 nearly horizontal from before backwards, its 

 posterior part projecting very much behind 

 (see fig. 120. a). It was sunk so much between 

 the ilia that the centre of the 4th lumbar ver- 

 tebra was opposite to the upper border of the 

 pubic symphysis, and was bent so much about 

 the 3rd sacral vertebra, that the distance of the 

 apex from the promontory was only 1 inch 9 

 lines, and from the first transverse sacral line, 

 only 15 lines. The innominate bones were 

 thin and slender, and the centres of the iliac 

 wings more translucent than in the healthy 

 bone. On the planes of the ischia was the 

 cracked pasteboard fissure, running obliquely 

 from above downwards and forwards opposite 

 the cotyloid cavities, and said to be charac- 

 teristic of the pelvis diseased by malacosteon. 

 The left tuber ischii was more elevated than 

 the right, and the ascending branch of the 

 same bone more bent. A direct line drawn 

 from one anterior superior iliac spine to the 

 other, cut the body of the 4th lumbar ver- 

 tebra 3 lines below its upper surface (d\ and 

 measured 8 inches 7 lines. From the anterior 

 inferior iliac spine to the posterior extremity 

 of the linea innominata, measured on both 

 sides, 2 inches. From the ischial tuberosity 



Angular rickety pelvis. (After Naegele.) 

 to the most elevated portion of the iliac crest, 

 measured on the right side, 6 inches, on the 

 left, 5 inches 7 lines. From the tuber ischii to 

 the pectineal eminence, measured on the right 

 side, 3 inches ; on the left, 2 inches 11 lines. 

 The height of the pubic symphysis was IS 

 lines. 



The superior opening was angular, with an 

 acute and somewhat symmetrical curve of the 

 cotylo-sacral ribs on each side, and a gradual 

 and equable curve inwards at the union of the 

 ilium and superior pubic rami at the aceta- 

 bula (Z>), which brings the body or acetabular 

 portion of the pubis, to within 5 lines of the 

 body of the 4th lumbar vertebra, the under 

 surface of which is on the same level ; the same 

 measurement on the left side being 6^ lines. 

 The distance from the anterior and lower 

 border of the same vertebra to the upper 

 border of the pubic symphysis, was 1 in. 

 1 line ; and from one superior branch of the 

 puj>is to the other near the acetabula, 1 in. 

 7 lines. The pubis presented the usual out- 

 ward bend at the spines on each side of the 

 symphysis (c). At the inferior opening, the 

 distance between the ischial tuberosities was 

 1 in. 5 lines only; and the nearest approxi- 

 mation of the ascending branches, 1 in. 1 line. 



The shape of this pelvis, of which the author 

 gives three lithographic sketches, had caused it 

 to be frequently mistaken for the results ofmol- 

 lities ossiuni) but the appearance of the bones in 

 texture, lightness, and slenderness, c., was 

 truly rickety, and with the history of the 

 case, gave no reason whatever for the sup- 

 position that malacosteon had ever been pre- 

 sent or supervened. 



In addition to this case, the same eminent 

 observer adds, that he has himself seen two 

 examples of this deformity in children, and that 

 in the pathological collection at Strasbourg, as 

 he was informed by Professor Stoltz, that there 

 are two skeletons of rickety children, of one 

 and eight years old respectively, in which the 

 pelves are affected with the angular deformity. 

 In the Anatomical Museum at Breslau, also, 

 on the authority of Professor Betschler, is 

 another example of this kind, exhibited by 

 the pelvis of a rickety female child aged 

 ten years. Many other similar examples are 

 given by Burns, Otto, Wallach, and Krum- 

 bolz. Rokitansky also found the angular de- 

 formity in rickety pelves, but in a minor 

 degree of distortion.* 



In the Museum of King's College, London, 

 are two rickety pelves of children of about 

 from four to six years old, both of which are 

 affected with angular deformity of the pelvis. 



Fig. 121. 



Angular child 's pelms from rickets. 



A drawing of one of these is given in figure 

 121. In the larger of the two, the curves of 

 the femurs and leg bones are bent di- 



* Pathological Anatomy : Pelvic Abnormalities. 



