6 THE TOxNER LECTURES. 



But in all the other 21 eases no eause was assignable, and it 

 is, therefore, likely that it was mere muscular contraction which 

 becomes, at the time when these occur, more vigorous as health 

 gradually returns. Seitz has recorded one of the most remark- 

 able cases in which, from extensive bedsores, the abdominal 

 decubitus was maintained for nearly a month, and he supposes 

 that this was the immediate cause of the dislocation. But as 

 in no other case is this posture noted, it cannot be regarded 

 as correct. Indeed, if posture have any influence, as the dis- 

 location is generally if not always iliac, the dorsal decubitus 

 would be the most favorable for its production. In one of the 

 shoulder cases a subcoracoid luxation was caused by the 

 patient's assuming the erect posture. Gravity had here 

 probably some influence, together with the muscular exertion. 

 The dislocation of the knee also was posterior. 



A remarkable case corroborative of the non-specific character 

 of the lesion and the probable influence of gravity, I have lately 

 seen in the service of Dr. Wm. G. Porter, at St. Mary's Hos- 

 pital. The child was about two 3'ears of age, greatly exhausted 

 from mal-nutrition, and for about six weeks was kept alive by 

 inunctions of sweet oil, no other nourishment whatever being 

 given. It had large abscesses in different parts of the body, 

 and at present has necrosis of the left humerus. Early in the 

 period of returning strength and before the necrosis appeared, 

 spontaneous luxation of the left humerus into the axilla oc- 

 curred. It was easily reduced by manipulation, and has not 

 since recurred. 



Typhoid was noted as the preceding fever in 15 and typhus 

 in 7 of the hip cases. Sex has a marked predisposing influence 

 in this, as we shall find in other diseases, for of 23 cases 15 

 were males and only 8 females. The age at which they occur 

 is still more noteworthy: 15 were under 15 years, 6 from 15 to 

 20, 1 was 30, and 1 was 61 years old ; that is, 21 out of 23 were 

 under 20 years old. The analogy to coxalgia, it will be ob- 



