ABNORMAL CONDITIONS OF THE HIP-JOINT. 



783 



has frequently examined, (jig. 308,) the thigh, 

 leg, and foot were by no means inverted, the 

 ordinary aspect of the front of the femur, patella, 

 &c. was directed as much forwards as it 

 naturally is ; the shortening and other signs of 

 luxation upwards on the dorsum ilii existed, 

 and, in consequence of the emaciated state of 

 the limb, the relative position of the head and 

 neck of the femur, above adverted to, was easily 

 recognized, when the hand was laid upon the 

 head of the bone, and a strong movement of 

 rotation outward was communicated to the mal- 

 formed extremity. 



We do not mean to assert that in all cases 

 this relative position of the head and neck of 

 the femur will be found to exist; in this, as in 

 other congenital defects, much variety may be 

 expected to be found. When in these cases 

 the soft parts are removed, the bones of the 

 pelvis present appearances which are remark- 

 able enough, although we believe that these 

 appearances have heretofore escaped the obser- 

 vation of anatomists, who seem to have confined 

 their attention to the abnormal condition of the 

 head of the os femoris and the acetabulum. 



The anterior spines of the ilium, particularly 

 the inferior, we have usually found to be directed 

 very much inwards, towards each other (Jig. 

 307); the external iliac fossa to be more convex, 

 and the internal iliac fossa more concave than 

 usual : beneath the anterior inferior spine we no- 

 tice a deep groove directed outwards, through 

 which the united tendon and fibres of the psoas 

 and iliacus pass to the lesser trochanter of the 

 femur, which process is always in these cases 

 placed so much behind as well as above its nor- 

 mal situation. The sub-pubic angle is remark- 

 ably obtuse, the rami of the pubes and ischia 

 are very oblique, and the tuberosities of the 

 ischia greatly everted. 



Fig. 307. 



Many of these which we would call charac- 

 teristic features of the double congenital defect 

 now under consideration have heretofore escaped 



the notice of all those who have written on 

 " the original luxation" of the hip-joint. San- 

 difort in his Museum Anatomicum has, how- 

 ever, given a delineation of a pelvis belonging 

 to a subject in which he says both hip-joints 

 were found dislocated: what this author has 

 there drawn was probably not understood in 

 his day, but any one who has seen many spe- 

 cimens of the deformity we are now endea- 

 vouring to describe, will agree with us, we are 

 sure, in considering Plate LXIV a true repre- 

 sentation of congenital luxation in both hip- 

 joints. 



When only one of the hip-joints is affected 

 we find a lateral curvature of the spine to exist, 

 and the bones of the pelvis to be in a state of 

 atrophy on the malformed side. The portions 

 of the os pubis and ischium which circum- 

 scribe the thyroid foramen are generally long 

 and slender, and the tuberosity of the is- 

 chium is at a greater distance from the sym- 

 physis of the pubis on the malformed than on 

 the opposite side. 



Many of the anatomical characters we have 

 here stated may be supposed to be the gradual 

 result of causes acting from early infancy on 

 bones as yet soft and cartilaginous. The weight 

 of the body so constantly acting unfavourably 

 on badly-formed bones and over-distended liga- 

 ments, the efforts of muscles by their repeated 

 exertions endeavouring to supply the defici- 

 encies in the ligaments and in the articular sur- 

 faces of the bones, are so many causes which 

 must act on and alter the direction of the head 

 and neck of the femur, distort the tuberosities 

 of the ischia, and draw towards the middle 

 line the spines of the ilium; but we may inquire 

 does the first fault in these cases consist in the 

 arrest of development in the bones? in the 

 muscles? or should we look to the nervous 

 system for the primitive source of these intra- 

 uterine defects ? These are inquiries which can- 

 not, we believe, in the present state of our know- 

 ledge, be satisfactorily replied to. Andral re- 

 marks that in almost all cases in which one of 

 the cerebral hemispheres is atrophied we find 

 the limbs of the opposite side less developed 

 than natural ; but he does not venture to ex- 

 press an opinion as to whether the imperfect 

 de/elopment of the brain is the cause of the 

 malformed extremity, or the repose and want 

 of use of the latter the reflected cause of the 

 atrophy of the brain. No doubt we have, in 

 one solitary instance already quoted,* shewn 

 that a congenital malformation of the left hip- 

 joint coincided with a deficiency of the cerebral 

 convolutions of the right hemisphere of the 

 brain, but this coincidence we have reason to 

 believe must be exceedingly rare. 



Some surgeons of eminence, whose opinions 

 must have considerable weight with the pro- 

 fession, have stated it to be their belieff that 

 " a simple paralytic condition of the muscles of 

 the lower extremity, as a consequence of the 

 irritation from teething arising during infancy," 

 is the starting point of disease in these cases, 



* Dr. Hutton's case, Dublin Journal, volume viii 

 t See Lancet for 1825-6. 



