A like case of progressive pelvic deformity from mollifies ossiuni 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 ag,ain became pregnant, when the sacro-pubic diameter was found to be reduced to I inch, becoming gradually narrower on each side. CTsarian section was performed, under w hich she sank. After death, the sub-pubic arch was found to be so much contracted, that the sciatic rami were little niore 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 wornan, on whom lie 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 from malacosteon, the woman had previously borne children, and been deli vered by the crotchet. In this instance, the conjugate diameter was reduced to 11. inch ; the right sacro-cotyloid, to 2i ; 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.-t 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 mmonds, 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, w ith contraction of both outlets, was of malacosteon ; and the opinion seems ti) 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 " 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 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, Nvhich 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 mollifies ossium, a rickets of adult:, in which cases the pelvis will assume the cordiform shape. The frequent occurrence of spinal deforruities at this age, is an eNidence 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 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 Cmsarian section.