PELVIS. 



205 



Whether these pelves and those mentioned 

 by Rokitansky are not similar to those de- 

 scribed by Naegele as arrest of development 

 of one side of the first sacral bone, is a 

 question which can only be decided by ab- 

 solute comparison of the specimens. 



A greater or more advanced development 

 of one side of the pelvis than the other is 

 said bv Knox, in a memoir " On the Statistics 

 of Hernia," to be frequently seen, and to pro- 

 duce a greater predisposition to hernia on 

 that side. The author considers it as the 

 result of a similar want of balance between 

 the development of the lateral halves of the 

 pelvis to that seen, in a greater degree, in the 

 "pelvis oblique ouata" and which is also often 

 seen between that of the true and false pelvis. 



Pelvis obstructed by exostosis. Exostoses 

 projecting from the pelvic bones most usually 

 proceed from their internal surfaces, in which 

 position they are also of more serious im- 

 portance in producing obstruction to parturi- 

 tion in the female. According to Ramsbotham, 

 it is a rare condition of the pelvis, he having 

 never seen an instance. Exostoses are most 

 frequently found at the back part of the pelvic 

 cavity, growing from the sacrum, near the 

 sacro-iliac joint, or, according to Lever, at the 

 last sacral piece. They are, however, by no 

 means confined to these positions. 



Many instances of this disease have been 

 recorded, in which the diagnosis has not been 

 verified by post-mortem examination ; and it 

 is doubtful whether many of them were not 

 projections of the sacral promontory and 

 lumbar vertebrae, as in a case described by 

 Nagelin the Frankfurter Zeitung (April, 1778). 

 It has been observed in the male as well as in 

 the female pelvis. 



One of the most remarkable cases of ex- 

 ostosis of the sacrum, producing obstruction 

 to parturition, occurred to Dr. Haber, and 

 is recorded in Naegele's Inaugural Disser- 

 tation, published at Heidelberg in 1830. 

 The disease was said to have followed a fall 

 while the woman was carrying a load on her 

 head, and which was followed by pains in the 

 back and pelvis. On afterwards becoming 

 pregnant, the whole of the pelvic cavity was 

 found to be filled by a bony tumour growing 

 from the upper part of the sacrum. The 

 Caesarian section was performed ; and the 

 patient died soon afterwards. The tumour 

 was found to be 7 inches long by 6 in. broad, 

 reaching as hih as the junction of the 3rd 

 and 4th" lumbar vertebrae and as low as from 

 about 2^ lines from the apex of the sacrum. 

 Between it and the posterior surface of the 

 pubes there was a space of 8 or 10 lines in 

 one part, but only a line and a half in another, 

 the mass thus filling up nearly the whole of 

 the pelvic brim. A section of the tumour 

 showed large cells in the interior, communi- 

 cating freely with the sacral areolae. 



Another remarkable case is recorded in the 

 Edin. Med. and Surg. Journal (April, 1831), 

 for which hysterotomy was performed by Dr. 

 M'Kibbin, Surgeon to the Lying-in Hospital, 

 Belfast. The patient had suffered a fall on 



the back when about six or eight years of age, 

 which was followed by pains in the sacral 

 region for a short time afterwards. The ex- 

 ostosis was of a conical form, with the base 

 at the sacrum (see^g. 125.), and occupying 

 its whole breadth at about the four lower 

 sacral pieces, its apex projecting towards the 

 pubis, and leaving a space of only 1 inch 

 between it and the lower part of the pubic 



Fig. 125. 



Exostosis of the sacrum. 



symphysis. The greatest space was left op- 

 posite the superior ramus of the right pubis, 

 where the distance of the tumour from the 

 pubic wall was from 1J to If inches, but di- 

 minished posteriorly. The patient died soon 

 after the operation ; nor was the child saved. 



A less formidable case came under Dr. 

 Murphy's observation. The tumour was about 

 the size of an orange, and was connected to 

 the sacrum about its middle. It was quite 

 immoveable, and of bony hardness. The pa- 

 tient being in labour, craniotomy was per- 

 formed ; and the case did well. Another case 

 is recorded by Van Doevern, of an osseous 

 tumour, of the size of half a hen's egg, grow- 

 ing from the upper piece of the sacrum, and 

 causing the death of both mother and child. 



Dr. Kyle, of Cologne, met with a case of a 

 woman who had borne seven children with 

 great ease ; but at the eighth labour the foetal 

 head became impacted by a hard immoveable 

 tumour, as big as a hen's egg, springing from 

 the upper part of the right sacro-iliac joint, 

 being apparently the result of a pelvic abscess 

 after the last delivery, which had, three years 

 before, opened in the groin. 



Dr. Lever has seen but one case of pelvic 

 exostosis. It occurred in'an unmarried female 

 lunatic, and grew from the posterior surface of 

 the pubis, producing retention of urine.* Las- 

 sus describes processes of bone, of a styloid 

 shape, projecting from the posterior surface 

 of the pubis towards the bladder.f These 

 resulted, apparently, from ossification of the 

 anterior ligaments of that viscus. Besides 

 these, an exostosis is mentioned by Velpeau 

 (Tocologie), protruding from the posterior 

 surface of the right pubis, and of the size of 

 a hen's egg a little flattened ; and others by 

 Pinaeus, Ruleau, and Portal, from an anky- 

 losed symphysis pubis. 



One is alluded to by Naegele, which was as 



* Guy's Hospital Reports, Xo. 14, April, 1842. , 

 \ Pathologic Chirurgicale (Paris, 1805, chap. 80.). 



