800 



ABNORMAL CONDITIONS OF THE HIP-JOINT. 



of the fossa which is normally destined to con- 

 tain the substance called Haversian gland, the 

 shortening of the neck of the femur and depres- 

 sion of the head towards the lesser trochanter, 

 and the ivory deposition on it. In this view Mr. 

 Smith, who had so well described the disease in 

 question, and the hospital surgeons around him, 

 concurred, and Mr. Snow Harris himself quickly 

 became a convert to our views, and we are sa- 

 tisfied from what we observed of his liberality, 

 thatwe have his full permission to communicate 

 this case in its present form to the profession. 

 The sketch (jig. 315) is taken from the cast of the 



Fig. 315. 



Fig. 316. 



Mr. Snow Harris's case. 



head and neck of the femur presented by Mr. 

 Harris to the College of Surgeons, Dublin. The 

 upper part of the head of the femur was exceed- 

 ingly rough on its surface, and of an oval form 

 from above downwards ; the axis of the neck 

 was at right angles with the shaft, and seemed 

 to run horizontally inwards and backwards, so 

 that the length of the fossa which exists poste- 

 riorly between the corona of the head and the 

 posterior inter-trochanteric line, was in this case 

 less than a quarter of an inch, a fossa which 

 we know naturally measures two inches. In 

 viewing the oval form of the head, we conclude 

 the movement of rotation must have been im- 

 possible ; from the shortening of the neck pos- 

 teriorly, we can infer that the toe and foot must 

 have been greatly everted, and from the depres- 

 sion of the head, to the level of the trochanter, 

 the femur must have been nearly one inch 

 shorter than the other. The lamented indivi- 

 dual had not suffered from the disease more 

 than ten years, so that the morbid appearances 

 were not to the same amount as we are accus- 

 tomed to see as the result of this very slow dis- 

 ease. 



The following case is that of an individual 

 who has been, to the writer's knowledge, suffer- 

 ing for many years under this disease. 



Patrick Macken, now aged seventy-seven 

 years, was brought up as a postilion and groom, 

 but for the last seventeen years has been quite 

 unh' t for service in consequence of his having 

 been afflicted with a very severe pain in his 

 right hip ; from the first attack of which he be- 

 came lame, and ever since the lameness has 

 been slowly but gradually increasing. In every 



Chronic rheumatic arthritis of the Hip. 



other respect his health is excellent, except tliat 

 he has some wandering rheumatic pains in other 

 joints, particularly in the right shoulder. 



Hewalkswith great labour and pain, and now 

 requires the assistance of a stick in each hand (fig. 

 31 6); in the morning his movements are stiff and 

 confined, but they become freer on exercise; in 

 theeveningof a day he has walked much, the pain 

 and stiffness are worse and increased in propor- 

 tion to the excess of exercise and labour he had 

 undergone in the day. While he remains in bed 

 he rests on the affected hip, and suffers no pain 

 whatever except he suddenly turns himself in- 

 cautiously. As soon as he gets up and throws his 

 entire weight on the diseased hip-joint, the pain 

 commences; if asked in what particular part of 

 the joint he feels most suffering, he points to the 

 back part of the great trochanter and to a point 

 which corresponds to the situation of the lesser 

 trochanter ; he says the pain shoots from these 

 points down the front of the thigh to the knee. 

 These pains are sometimes more severe, and 

 sometimes less, without his being able to as- 

 sign any cause for these alterations, and he can- 

 not observe that the state of the weather has any 

 influence on them whatever. 



As he stands at rest, he throws the weight 

 of his body on the left or unaffected limb, 



