ABNORMAL CONDITIONS OF THE HIP-JOINT. 



781 



wards, forwards, and inwards, and this obliquity 

 is greater in proportion as the pelvis is broader; 

 hence the deformity in the female increases 

 about the age of puberty : there is, in conse- 

 quence of this breadth of the pelvis, a tendency 

 of the limbs to cross each other inferiorly, and 

 the movements they are found to enjoy are 

 very limited, particularly those of abduction 

 and rotation ; hence the individual finds great 

 difficulty in performing the different functions 

 belonging naturally to the inferior limbs. 

 When we examine a person with this double 

 defect standing, we are struck at once with the 

 apparent want of proportion between the superior 

 and inferior parts of the body, with the imper- 

 fection of the lower limbs, and with the peculiar 

 attitude of the patient. The trunk is fully deve- 

 loped, says Dupuytreu, whilst the inferior limbs, 

 short and slender, seem as if they were suited 

 only to an individual of smaller stature, When 

 we view the patient laterally, we observe that the 

 chest and superior part of the body are carried 

 very much backwards, while the anterior part 

 of the abdomen is thrown very prominently 

 forwards, and at the same time we notice there 

 is a corresponding hollowing posteriorly in the 

 region of the loins, and that the nates jut out 

 backwards most conspicuously. A very cha- 

 racteristic circumstance relative to the standing 

 position of these malformed individuals is, that 

 they rest on the ground only by the anterior 

 part of their feet; most of the peculiar cir- 

 cumstances relating to the attitude of these 

 persons follow as the necessary consequence of 

 their hip-joints (or in other words the centre 

 of motion of the lower extremities) being placed 

 behind their ordinary situation with respect to 

 the pelvis. 



If a patient so unhappily constituted wish to 

 walk, we see him incline the superior part of 

 his body towards the limb which is now in- 

 tended to support the weight of the body ; he 

 as it were balances himself on the anterior part 

 of the foot of this side ; he next raises from the 

 ground the opposite foot, and transfers labori- 

 ously his weight from one side to the other 

 indeed each time this motion takes place, the 

 head of the femur which receives the weight of 

 the body, ascends upon the external iliac fossa, 

 and is sustained by its ligaments and muscles ; 

 the pelvis is at the same time depressed, and 

 all the signs of displacement become more ob- 

 vious on this side, while they diminish sensibly 

 on the other ; in a word, progression thus be- 

 comes an awkward and waddling movement. 



It may appear singular that running and 

 leaping should be executed by these patients 

 with more facility than walking, yet such is 

 the fact; for in those exertions the energy of 

 muscular contraction, and the rapidity with 

 which the weight of the body is transferred from 

 one limb to the other, are such, that the want 

 of a true acetabulum is not so much felt 

 as in walking. Any of these exercises, how- 

 ever, very soon induce fatigue, which we can 

 readily account for when we recollect the 

 friction which the head of the femur must un- 

 dergo against the side of the pelvis, and the 

 great efforts which the muscles have to sustain 



in supporting the weight of the body, during the 

 balancing or waddling motion described. When 

 persons afflicted with this malformation lie 

 down horizontally on their back, the signs of 

 their infirmity become so slight as to be 

 scarcely perceptible, because in this situation 

 of complete repose the muscles do not draw 

 upwards the lower limbs, nor does the weight 

 of the body depress the pelvis. Dupuytren 

 found that in this situation of the body he 

 could elongate or shorten the affected limbs 

 of the patient; to elongate them, he says, it 

 was merely necessary to pull slightly down- 

 wards at the knee or ankle, and to shorten 

 them, to push them upwards; the head of the 

 femur will undergo in such experiments a dis- 

 placement of one, two, or even three inches 

 (Dupuytren), and all these displacements will 

 be affected without causing any pain and with 

 the greatest ease, convincing us that no proper 

 cavity exists fit to receive and retain the head 

 of the femur. 



It is of importance that this congenital mal- 

 formation of the hip-joint should be well under- 

 stood, not only that dangerous errors in diagnosis 

 may be avoided, but that this defect, when it 

 really exists, may be recognized early, so that 

 timely and proper treatment may be resorted to. 

 It presents to the superficial observer many of 

 the signs which belong to a disease of the hip- 

 joint ; and of the cases seen by Dupuytren, few, 

 he says, had been recognized by the surgeons 

 previously consulted : almost all these unfor- 

 tunate patients had been subjected to painful and 

 worse than useless treatment. Many individuals 

 afflicted with original luxation of the hip-joint 

 have been, in consequence of the errors or igno- 

 rance of their medical attendants, condemned 

 to keep their beds during many years. " I have 

 seen others," says he, " whom they had forced to 

 submit to numberless applications of leeches, 

 blisters, issues, and moxas; among others I 

 remember the case of a young girl, who suffered 

 the application of twenty-one moxas around the 

 hip, without this barbarous treatment having 

 effected any favourable change in the situation 

 of this unfortunate patient." 



We can easily distinguish this original 

 luxation from disease of the hip-joint, as there 

 is no pain felt by the patient either in the hip 

 or knee ; there is neither heat, swelling, nor 

 abscess, no evidence of inflammation chronic or 

 acute, nor is there any cicatrix ; consequently 

 nothing exists which can induce us to believe 

 that heretofore there ever existed any abscess or 

 fistula, consequences so very usual in cases of 

 disease of the hip-joint, when this disease has 

 arrived at the stage of luxation. 



Dupuytren's description of this condition of 

 the hip-joint seems to apply altogether to the 

 case in which both joints are engaged ; when 

 one articulation only is affected, so far as 

 it is concerned, the features of the congenital 

 defect are just as well marked as those above 

 alluded to. The usual signs of the dislocation 

 upwards and backwards on the dorsum ilii, and 

 the same range of ascent and descent of the head 

 of the femur on the ilium and towards the ischi- 

 atic notch, is noticed as in the former case ; as, 



