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 Cmsarian section, also resulting frotn malacosteon, the woman had previously borne children, and been deli vered by the crotchet. In this instance, the conjugate diameter was reduced to 4 inch ; the right sacro-cotyloid, to 21; the left, to I 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 cordiform shape, is one which has occupied consider ably the attention of many obstetricians.
It was very ingeniously advocated by Dr. Hull in his Letters to Sy almonds, and laid down by the younger Stein and others on the Continent, that the ovate form of pelvic dis tortion with contraction or 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 ofmalacosteen; 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 mollifies ossium, yet that " or necessity, the softened adult pel vis would take the shape called cordiform, while the infant pelvis would be transiersely 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 fig,ured, in which cases he supposes that angular defonnity 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 in 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 fetnales, whose health is depreciated, and poaers of nutrition impaired, by the con fined or unhealthy nature of their employ- ment ; and that there is thus constituted a special kind of mollifies ossium, a rickets of adults, in which eases 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 argutnents 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 deforrnity 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, shambl:ng, w addling gait, and a remark even before incineration, left, after exposure to a red heat for some time, a very porous and light inorganic structure. The following results were obtained by thus burning oft' the organic components-100 grains of hone,— From the body of an upper lumbar bra left—of earthy matter - 31 „ the last lumbar vertebra - - 27 „ lower end of the sacrum - 24 „ ilium (cotylo-sacral rib) - - 40 „ ischium (near tuberosity) - - 36 „ pubes (near acetabulum) - - 33 „ head of the femur - - 22 „ neck of the femur - - - 25 „ shaft of the femur (below trochant) 58 When we compare the foregoing propor tions of the two constituents of bone with those given by Schreger, as the normal pro portions of adult bone — viz., 20.18 animal, and 74'84 earthy matter—the diminution of the inorganic constituents appears very striking, and still greater when compared with those of aged bone ; although less so than in the re sults of the analy sis of Dr. Leeson, in the extreme case recorded by Mr. Sony before given.