—The lesion is recognized by certain alterations of gait, with a sharp lumbar lordosis and unduly prominent buttocks and iliac crests, so that these patients much resemble those having congenital hip dislocation, the pubes being higher and the sacrum lower than the normal, this diminution of pelvic obliquity being practically always pathognomonic. On vaginal or rectal examination undue prominence may be felt above the sacrum. Some of these cases complain of much pain, either local or referred, down the limb, the same being made worse by exercise.
PLATE XXXVIII
Sarcoma of the Spine and Cord. (Goldthwait.)
Diagnosis.
—Diagnosis should be made as between this condition, Pott’s disease, double congenital dislocation of the hip, and rickets.
Treatment.
—The condition does not admit of extended treatment, save that a certain proportion of cases are benefited by such fixation as is afforded by a plaster jacket, which firmly encloses the pelvis and supports the lower part of the trunk upon it.
KNOCK-KNEE AND BOW-LEG.
The plane of the terminal articular surface of the lower end of the femur is not at right angles with the axis of its shaft; in other words, the inner condyle is placed a little lower or beyond the location of the outer. In this way sufficient angular arrangement of the leg upon the thigh is permitted so that, with the upper ends of the femora separated by the width of the pelvis, the knees and the ankles may, under normal circumstances, be made to touch when the limbs are fully extended. Thus a slight degree of angular deflection at the knee is normal. When this is exaggerated to a degree not permitting the ankles to touch when the knees are in contact the condition is known as genu valgum, or knock-knee. When, on the other hand, the angle is lessened or reversed so that the knees are more or less separated when the ankles are in contact the condition is then known as genu varum, or bow-leg. These two conditions constitute the typical and classical types of knock-knee and bow-leg. Other conditions, however, which lead to the same result occur through various and irregular curvatures or irregularities of the femur or the tibia, or both, and there thus may be produced atypical yet most pronounced instances of these same deformities. These deformities may be apparent almost from birth, may appear during early childhood, or not until adolescence. As a rule they are not manifested until young children are learning to walk. Whenever they appear before this time they are expressions of infantile rickets, which should be recognized as such and corrected by mere manipulation while the bones are still flexible, the correction being maintained, and by suitably feeding and medicating the patient. (See the general subject of [Rickets].)