A textbook of obstetrics . and overthe anterior portion of thepelvis. Every movementincreases these pains. Asthe disease progresses, thebones of the spinal columnare so bent and compressedthat the individual is dimin-ished in stature to an extra-ordinary degree. She maylose as much as a foot anda half in height (Fig. 313).The gait of an osteomalacicpatient is peculiar. Inorder to compensate forthe approximation of thethighs brought about bythe collapse of the pelvis,the individual must turnalmost through a half-circlein order to bring one footin front of the other. Bypalpation of the pelvis te
A textbook of obstetrics . and overthe anterior portion of thepelvis. Every movementincreases these pains. Asthe disease progresses, thebones of the spinal columnare so bent and compressedthat the individual is dimin-ished in stature to an extra-ordinary degree. She maylose as much as a foot anda half in height (Fig. 313).The gait of an osteomalacicpatient is peculiar. Inorder to compensate forthe approximation of thethighs brought about bythe collapse of the pelvis,the individual must turnalmost through a half-circlein order to bring one footin front of the other. Bypalpation of the pelvis ten-derness upon pressure isdiscovered over its anteriorwalls. The flexibility ofthe pelvic bones ma)- bedemonstrated by direct pressure, and an internal examinationreveals, in the early stage of the disease, the peculiar beak-likespace behind the symphysis, and later the almost entire oblitera-tion of the pelvic outlet and canal by the sinking in of the pelvicwalls. If it is possible to make a satisfactory internal cxamina-. Fig. 313. — Authors case of osteomalacia. A NOMA LIES IX I HE /? 0R( ES OF LABOR. 453 tion of the pelvis, the low position and the projection of thepromontory at once attract attention, and the sharp angulationon the anterior face of the sacrum can be felt. On account ofthe exaggerated inclination of the pelvis, it may be necessary to make an examination with the patient upon her side. An osteo-malacic pelvis has been taken for a kyphotic, a Robert, a pseudo-osteomalacic, a cancerous, or a fractured pelvis, but a careful,methodical examination of the patient will always lead to a cor-rect diagnosis. Influence Upon Labor.—The results of labor in osteomalacicpelves show that the obstruction is a serious one, although byreason of the flexibility of the pelvis in some cases the head candistend the pelvic canal sufficiently to pass through. In 85 casescollected by Litzmann, 47 ended fatally. In another series of 128cases the labor had a spontaneous terminatio
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