DIAGNOSIS OF PELVIC OF THE PELV IS. — P ra,v ETRY. -PE LVIG PRY.
The signs by which we may recognize pelvic deformity are of two kinds: Signs of probability; signs of certainty.
Signs of Probability.—Deformities of the pelvis are due, as we have seen, with the exception of certain cases of congenital deformity, to either general diseases, rickets, osteomalacia, or to local affections of the verte bral column, of the pelvis, or else, finally, to lesions of the inferior ex tremities.
Ordinarily, the history of the patient will give us a clue to the causal factor of the deformity, especially in case of rickets. A study of the writings of the older authors proves that they were familiar with this fact, and that they laid great stress on external examination of the patients. The external configuration, stature and symmetry of the patients, should, above all, attract our attention. It is usually women of small stature who present pelvic deformity, although, as we have seen, women of normal stature may also possess deformed pelves. In them, it is ordinarily from the history of antecedent labors that we obtain data pointing to pelvic de formity.
The form of the body calls for special attention. Women with broad hips and straight limbs rarely present pelvic deformity. Those of the reverse appearance are usually vitiated in the pelvis. Our suspicion of deformity will be the stronger in cases where the limbs are curved or shortened, or the spinal column is deviated.
Rickets is the most common cause of pelvic deformity. It developer in the first years of infancy; and interferes with normal growth. We must inquire, therefore, into the age when the women began to walk, and if walking has been difficult. At times walking was not attempted till the age of three to four, and again the women simply remember that walk ing was difficult, or that cod-liver oil was given them in infancy.
Rickets is an affection characterized by the fact that its march is pro gressive from below upwards. More or less pronounced deformities of
the lower limbs will be found, as also of the vertebral column, but the pelvic deformity is not at all always proportionate to that of the limbs. Although, in general, deformity of the lower limbs and of the pelvis march hand in hand, this is not the invariable rule. Women with pro nounced pelvic deformity may offer but little change in the limbs, and vice versa. These are the cases which are apt to deceive the accoucheur, and are unfortunate for the women in that no suspicion is evoked as to the gravity of the deformity until labor has set in. Hohl's theory, there fore, which deduces the shape of the pelvis from the degree of deformity of the extremities, is a fallible one. The same holds true of Weber's theory, which supposes an accordance between the form and volume of the skull and the capacity of the pelvis.
As for deviations of the vertebral column, the age at which they oc curred is of great importance. If they date from infancy, they are due to rickets, and then the woman is usually small, the limbs short and slen der, enlarged at their extremities, the thorax shows the characteristic chaplet, the head is large, the forehead and chin projecting. There has been, in a word, a true arrest of development. If, on the other hand, the spinal deviation is of later date, the changes are local. It is scoliosis, lordosis, kyphosis of the spine which are in the foreground. The limbs appear longer the more the thorax is diminished. The upper limbs reach the knees or lower, the legs are straight. Often then the pelvis is but little altered, but still such women should be carefully examined in re gard to pelvic capacity. (See the sections on lordosis, scoliosis, kypho sis.) In women who limp, whether this results from disease or from short ening of one or other femur, there is almost always associated pelvic de formity. We should always, hence, question the woman in regard to the cause of her limp.