On being examined, the lumbar vertebrm 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 (seefig. 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 91 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 lutnbar 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 The superior opening was angular, with an acute and somevvhat sy mmetrical 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 (b), 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 6i 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 pubis 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. lines only; and the nearest approxi mation of the ascending branches, lin. 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 of owl ossiun2, 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 tbis 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 ftom four to six years old, both of which are affected with angular deformity of the pelvis.
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.
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 rectly forwards, without any. lateral deviation inwards or outwards. In the Hunterian Museum also, there is a rickety skeleton of a child of six years, in which the pelvis presents the angular deforrnity and approxi mation of the acetabula. In none of these specimens is there any great backward curva ture of the spinal column, though, in the last instance, the sacrum is bent so much forward, that the tip of the coccyx is almost on a level with the superior plane in the centre of the opening.
It is, however, especially remarkable that in all these last-mentioned specimens, as well as in that figured by Naegele and just described, the angle of the bend or culm of the lateral curve produced by the pressure inwards of the heads of the femurs, takes place in the acetabula at the line of junction of the two upper pieces of the innominatum, and not in the superior branch_of the pubis itself, as in most of the cases resulting from mollifies ossium. This is evidently produced by the more facile and greater yielding of the as yet unossified cotyloid cartilage, rendered softer and more tardy in ossifying, by the effect of the disease upon its nutrition.
That such a 'yielding does take place in this cartilage from disease and pressure is shown still more strikingly in another case in the Hunterian Museum (No. 3423.), in In hich it has bent outwards, instead of inwards, and thus is produced an elliptical distortion of the pelvis. This skeleton is from a young subject, in which the pelvic bones had not yet become soldered together. The head and neck of the left femur are nearly destroyed by caries, which doubtless also extends to the acetabulum itself. Both the femurs are extremely flexed and adducted on the pelvis, and seem, espe cially on the diseased side, to have, by the constancy of this position, pushed upwards and backwards the pubis, so as to cause a distinct bend at the cartilaginous cotyloid line of junction, and an elevation of the pubic symphysis. By this means, the acetabula are pushed outwards, and the superior pelvic opening assumes an elliptical shape; though the cotylo-sacral arch is but slightly spread out, and the ischial tuberosities are normally placed. The lumbar curve and sacral pro monotory deviate slightly towards the left side, and the bones are remarkably small and light, showing the prevalence of the rickety tendency.