SURGICAL COMPLICATIONS AND SEQUELS OF FEVERS. 5 



seen at once when we consider that of the 43 cases named, 

 spontaneous dislocations occiu-red twenty-seven times in the 

 hip, twice in tlie shoulder, and once in the knee. 



These dislocations require more particular notice. From 

 their similarity to febrile arthritis in the same and other 

 joints their pathology seems clear, although — in singular 

 contrast to the strangely fatal laryngeal stenosis I shall soon 

 consider — not a single death has occurred, and therefore no 

 post-mortem verification has been possible. They belong to 

 the class of " Distension-luxations." That the cause is not the 

 specific poison is evident, since similar results follow other and 

 dissimilar diseases, such as locomotor ataxia, the exanthe- 

 matous fevers, hemiplegia, sciatica, and rheumatism, as pointed 

 out by Stanley in 1841.' 



Usually in the period of convalescence, following, therefore, 

 the prolonged exhaustion, there arises a subacute synovitis 

 with a gradual serous distension of the capsular ligament, 

 which, having reached a certain point, may slowly subside, and 

 no further evil follow. In 3 cases, however, this burst exter- 

 nallj', producing sinuses, but in none of them was the dis- 

 charge purulent. The main result is a slow, generally unper- 

 ceived, elongation of the ligaments, e. g. of the hip, with perhaps 

 also a swelling of the so-called gland at the bottom of the 

 acetabulum. This distension will spend its force mainly poste- 

 riorly, since the inverted Y ligament reenforces the capsular 

 ligament in front. Given this condition, the slightest force 

 will dislocate the head of the femur upwards and backwards 

 on the dorsum of the ilium. In one case a fall to the floor 

 produced it, in three others turning over in bed, and twice the 

 lifting of the patient in the arms from one bed to another. 



' On dislocation espec. of the hip-joint. Med. Chir. Trans, xxiv. 123. 

 See also Malgaigne, Fract, and Disloc, Paris, 1855, ii. pp. 218-226, 



882-887. 



