796 



ABNORMAL CONDITIONS OF THE HIP-JOINT. 



author, as we have very generally found osseous 

 growths exterior to the hip-joint in the os inno- 

 minatum and femur, ffig. 310), as the result 

 of scrofulous inflammation of the articulation. 

 These growths are generally friable stalactiform 

 productions which beset the bones, and are to 

 be seen in the numerous specimens illustrating 

 the morbid anatomy of morbus coxae, which 

 are contained in our museums in Dublin.* 

 Notwithstanding these osseous productions or 

 vegetations, the bones are found to have dimi- 

 nished much in their specific gravity. I have 

 always found them float when thrown into 

 water. These growths are, however, only met 

 with in the post-mortem examination of such 

 chronic cases as have manifested in their course 

 various alternations of improvement and re- 

 verses ; they are almost invariably found when 

 the caries of the bones had been arrested, and 

 an imperfect attempt at anchylosis had been 

 made. 



We have also opportunities of examining 

 anatomically the hip-joints of persons who have 

 had this disease in their youth, in whom it had 

 been arrested in the second or third stage, and 

 who had attained advanced life, and died of 

 some other complaint. In some, besides the 

 bony growths already alluded to, we find ex- 

 amples of anchylosis or of a false joint; indeed, 

 although an absolute union and consolidation 

 of the bones, viz. the os innominatum and 

 the head of the femur may not have taken 

 place, still in most cases there is very little 

 real motion of the two bones upon each other ; 

 the flexor and adductor muscles of the thigh 

 and hip-joint are usually in a state of spastic 

 contraction ; they admit of but little increase 

 of flexion : whenever we attempt extension, we 

 find the thigh is readily brought down from 

 the abdomen, the lumbar vertebrae are arched 

 forwards, and this portion of the spine and the 

 sacrolumbar articulation are the seat of motion, 

 which often is erroneously referred to the hip- 

 joint. The os innominatum follows the head 

 of the femur just as freely almost as the scapula 

 accompanies the various changes of position 

 impressed upon the humerus, when anchylosis 

 of the shoulder-joint has taken place. I was 

 called upon about eight years ago to examine 

 the body of a woman, aged 26 years, who died 

 in the Whitworth Hospital of an acute disease. 

 This young woman had walked very lamely for 

 many years, in consequence of her having had 

 a most tedious and dangerous attack of hip- 

 disease twenty years before her death, but after 

 her recovery from the first attack she never had 

 any pain or inflammation in the joint ; there 

 were no evidences of suppuration ever having 

 occurred ; marks of issues were on the nates. 

 When making an examination of the struc- 

 tures around the articulation and of the joint 

 itself, the muscles were found remarkably 

 firm, but somewhat paler than usual ; the 

 ligamentous structures around the junction of 



t These osseous vegetations we have already 

 alluded to in this work, when speaking of the chro- 

 nic strumous arthritis of the elbow : see p. 79, 



ELBOW-JOINT, ABNORMAL ANATOMY OF. 



the femur with the os innominatum were very 

 strong, and so close was the union of the bones 

 that on a superficial view we might easily ima- 

 gine that true bony anchylosis had occurred. 

 I removed the bones, and they are preserved in 

 the Richmond School Museum. The whole 

 head of the femur has been absorbed, and only 

 one-fourth part of the neck of the bone remains ; 

 the place of the cotyloid cavity is supplied by 

 a rough scabrous surface, of an oval form trans- 

 versely, and about one inch and one line in this 

 its longest diameter ; the two rough bony sur- 

 faces with eminences and depressions con- 

 fronted to each, and reciprocally adapted, were 

 joined by a species of strong fibrous capsule ; 

 no motion whatever existed between these 

 bones, yet when the ligamentous connexion 

 between them was cut, it was evident that no 

 bony union had taken place. In this case the 

 false anchylosis had occurred in a very unfa- 

 vourable direction ; the thigh was flexed to so 

 great a degree that the knee was really elevated 

 above the level of the hip-joint, and so much 

 adducted at the same time, that the knee crossed 

 much the middle line. When she stood up 

 straight on the right and perfect limb, the left 

 heel did not approach within twelve inches of 

 the ground : the texture of the bones was as 

 hard as iron. 



We find in a modern author the observation, 

 which must be admitted to be correct, that true 

 bony anchylosis of the hip-joint is rare ; but, 

 he adds, that many pathologists doubt that 

 such an occurrence ever takes place : that the 

 many specimens of true bony anchylosis of the 

 hip we have witnessed, were all examples of 

 union of bony surfaces in scrofulous cases, we 

 would not wish to maintain, but we imagine 

 many of them must have been the result of the 

 ordinary hip disease cured, as it is called, by 

 anchylosis. Sir Philip Crampton has shewn 

 me a very fine specimen of anchylosis of the 

 hip-joint, which very much resembles the pre- 

 paration represented (fig. 312); the acetabu- 

 lum had been the principal seat of the disease; 

 it was much widened, and the head of the bone 

 was drawn towards its upper and outer part, 

 where firm anchylosis had taken place. In 

 this case Sir P. Crampton assured me the pa- 

 tient had a constitution eminently scrofulous. 

 He got well of the hip-disease by anchylosis, 

 the thigh-bone having been judiciously pre- 

 served in a vertical direction during the pro- 

 gress of the cure. He walked afterwards tole- 

 rably well, but at the age of 26 became at- 

 tacked with phthisis, and died. This case 

 proves that true bony anchylosis can occur in 

 the scrofulous subject, and that attention may 

 occasionally overcome the disposition to exces- 

 sive flexion and adduction of the limb. 



The museum of the Richmond Hospital 

 contains three specimens, in which thejunction 

 of the os innominatum with the femur is as 

 solid as if they formed but one bone, and a 

 vertical section through the united bones shews 

 as free a communication of the cells of the 

 cervix femoris and those of the os innominatum 

 as if these bones had never been separately 

 formed. These seem to have been examples 



