786 



ABNORMAL CONDITIONS OF THE HIP-JOINT. 



ances which the post-mortem examination fur- 

 ther disclosed, we merely state that evidences 

 of diffuse inflammation of the mucous and 

 submucous tissues of the pharynx and larynx, 

 with purulent infiltration in the submucous 

 tissue, existed with extensive bronchitis, as 

 well as splcnization of the lungs. It was more- 

 over discovered that the right hemisphere of 

 the brain was deficient, and that a cyst five 

 inches in length and between two and three in 

 its transverse diameter occupied the interval 

 (which was an inch in depth) between the sur- 

 face of the atrophied brain and interior of the 

 calvarium ; this cyst was filled with limpid 

 serum. 



The whole of the left upper extremity was 

 in a state of atrophy, flexed at the elbow and 

 wrist-joints, and the forearm and hand were 

 rigidly pronated. 



A case of congenital luxation of the left hip- 

 joint very similar to the foregoing was under the 

 writer's observation for some time as an out-pa- 

 tient of the Richmond Hospital. This lad was 

 on different occasions seen and prescribed for 

 by Dr. Hutton, who first recognized the nature 

 of the case, and the other surgeons of the insti- 

 tution. His name was Martin Hannon ; he was 

 a labourer, aetat. 19 years. In his ordinary 

 attitude, standing, the spine wa? curved laterally 

 to the well-formed side, so that the line of gra- 

 vity seemed to pass to the ground through the 

 centre of the right or well-formed thigh and 

 leg : on this side the pelvis was depressed, and 

 on the opposite side elevated, so that the left 

 lower extremity appeared three inches shorter 

 than the right. The oblique position of the 

 pelvis above alluded to accounted for much of 

 this apparent shortening, which nevertheless, 

 by accurate measurement from the spine of 

 the ilium to the inner malleolus, was proved 

 to be real to a certain extent, viz. one inch and 

 a half. Next to the shortening of the limb, 

 the most remarkable circumstances which 

 caught our attention were the prominency and 

 elevation of the trochanter major, which was 

 found to be two inches above the horizontal 



Fig. 308. 



ramus of the pubis. The trochanter major was 

 also behind its usual situation (Jig.308). The 

 hip-joint possessed a certain degree of the mo- 

 tions of flexion and abduction, and when the 

 patient was directed to extend the thigh back- 

 wards, the motion about the sacro-lumbar arti- 

 culations seemed preternaturally free. When 

 the hand was placed on the left hip-joint, the 

 head of the femur could be felt plainly to be 

 situated in a very unusual position, namely, 

 forwards and upwards, close to the anterior 

 inferior spine of the ilium, and in advance 

 of its neck and the great trochanter, which 

 lay towards the ischiatic notch : if now a 

 motion of rotation outwards were commu- 

 nicated to the femur, the trochanter major 

 moved backwards, while the head of the femur 

 rolled forwards and outwards; and so very thin 

 was the patient that the head of the bone could 

 be seen and easily felt moving in this novel 

 situation. The deformed thigh was at its upper 

 part thrown much outwards (Jig. 308), and to re- 

 cover, as it were, this deviation outwards above, 

 it passed much inwards towards its lower ex- 

 tremity; the thigh and leg were cold and 

 atrophied, and the poor lad had also that mal- 

 formation of the ankle called valgus. 



He walked with the assistance of a stick, 

 and in consequence of the double defect of the 

 left hip-joint and ankle very imperfectly. 



The sound limb, which seemed, in standing, 

 to bear the whole weight of the body, was 

 very muscular, and was larger in proportion 

 than to be expected, when compared with the 

 left or deformed leg, thigh, chest, and upper 

 extremities, which last presented no peculi- 

 arities. 



Such were the notes the writer had taken of 

 this case in December 1837, when the lad ap- 

 plied to him at the hospital to be relieved of 

 an indolent ulcer he had on the weak limb. 

 In the beginning of the spring of this year 

 he became affected with phthisis, and died of 

 that disease in the Whitworth Hospital on the 

 12th June, 1838. Mr. Smith had a cast taken 

 of the lower part of the body, pelvis, and lower 

 extremities, which is preserved in our Museum. 

 The interior of the thorax presented the usual 

 effects of phthisis. 



Left hip-joint. The muscles around the 

 joint were remarkably pale and greatly attenu- 

 ated ; they held the same position relatively to 

 the head of the bone, as in the preceding case 

 of North, but they were more atrophied ; 

 in many places all appearance of muscular 

 fibre was lost, and its place supplied by a 

 yellow fatty fibrous tissue. The muscles of 

 the rest of the extremity, particularly the gas- 

 trocnemius and soloeus, were in a similar con- 

 dition. The sciatic nerve had not a very 

 healthy aspect; it was yellowish; and its fibres, 

 though firm, were more loosely connected than 

 usual. 



The capsular ligament was remarkably thick, 

 and was lined on its interior or synovial surface 

 with a very red vascular membrane, like scarlet 

 cloth. The internal ligament of the joint or 

 iiirunientum teres was fully three inches long, 

 and much stronger than usual (Jig. 309); it 



