ABNORMAL CONDITIONS OF THE HIP-JOINT. 



785 



half an inch ; in this particular this case dif- 

 fered from those given by Dupuytren, because 

 in his cases the range of motion of ascent and 

 descent of the head of the femur on the os 

 innominatum, which could be communicated, 

 amounted to two inches.* The body having 

 been placed on its face, and the integuments 

 removed from the glutseus maximus, this 

 muscle looked somewhat paler in its colour 

 than natural, its lower margin (which in the 

 natural state has a descent of obliquity amount- 

 ing to three inches) was placed nearly trans- 

 versely. When this muscle was removed, the 

 trochanter major presented itself; it lay on the 

 dorsum of the ilium, near to the ischiatic 

 notch, above the pyriformis and below the 

 range of the glutsei (medius et minimus), which 

 were in a state of atrophy. The head of the 

 femur, smaller than usual, was in advance of 

 the great trochanter, and was placed immedi- 

 ately external to the anterior inferior spinous 

 process of the ilium, and was here covered 

 immediately by the capsular ligament and some 

 scattered fibres of the lesser glutaei : the tensor 

 vagina? femoris lay in front of the head of the 

 bone. 



The pyriformis and quadratus were very 

 oblique in their course, passing upwardsand out- 

 wards : all the muscles in the front of the thigh, 

 such as the pectinalis and other adductors, passed 

 from the os pubis outwards with a degree of ob- 

 liquity three or four inches less than natural. 

 The psoas magnus was drawn a little outwards, 

 and its edges were twisted so that the internal 

 edge was directed backwards and its external 

 edge forwards. All the muscles of this ex- 

 tremity were smaller and less developed than 

 those of the other; but with the exception of 

 part of the obturator externus which looked 

 fatty, their fibres had a natural appearance. 

 There were no marks of previous violent injury 

 or chronic disease. 



The capsular ligament was attached as usual 

 to the circumference of the acetabuluin on one 

 part, and to the base of the neck of the femur 

 on the other; it was strong and at the same 

 time elongated, so as to allow the head of the 

 femur to rest on the dorsum of the ilium, but 

 ligamentary bands passed from this part of the 

 ilium to the external surface of the capsule, 

 where it invested the head of the femur; these 

 must have served to strengthen and fix the 

 capsule and thus prevent any great range of 

 motion over the ilium. When this capsule 

 was cut into, the head of the femur was found 

 somewhat conical in its form and much smaller 

 than usual; the cartilaginous covering, thin and 

 of an azure hue, did not form a very uniform 

 or perfect covering for the head of the bone ; 

 there seemed no deficiency of synovial fluid 

 within the joint. The inter-articular liga- 

 ment or ligamentum teres, as it is called, pre- 

 sented a very remarkable appearance ; it was 

 of unusual dimensions, being more than four 

 inches long; of a yellowish colour like tendon, 

 and as thick as the tendo Achillis near the os 



* See Dr. Button's account in the Dublin Jour- 

 nal, vol. viii. 

 VOL. II. 



calcis ; instead of being firm, round, and thick, 

 it was soft and could be easily spread out to 

 the breadth of an inch : its fibres were con- 

 nected by means of a thin transparent mem- 

 brane like a synovial structure. This sub- 

 stitute for the normal ligamentum teres was 

 continuous with the cotyloid ligament, or arose 

 from that part of it which completes the notch 

 of the acetabulum within. From this origin or 

 attachment, the ligament passed, as it were, 

 from within outwards and upwards to be at- 

 tached to the head of the femur, presenting in 

 its course an inverted arch, the cavity up- 

 wards and inwards, the convexity downwards 

 and outwards. On its inferior surface it cor- 

 responded to the head of the femur, where it 

 was hollowed out from before backwards, so as 

 to accommodate itself to the head of the bone, 

 for which it formed a kind of cup which follow- 

 ed the movements of the femur, affording it 

 always a receptacle as the inter-articular carti- 

 lage does for the condyle of the lower jaw. This 

 broad ligament had no connexion by synovial 

 folds or fibrous productions with the bottom of 

 the acetabulum. The cotyloid ligament was 

 flattened out round the brim of the acetabulum, 

 and was otherwise imperfect: the fatty and 

 vascular cellular structure named Haversian 

 gland existed in rather large quantity. 



When a comparative view of the bones of the 

 pelvisand lower extremity of each side was taken, 

 it was manifest that the left lower extremity was 

 in a state of atrophy, that the thigh-bone was 

 straight and slender, and that the atrophy ex- 

 tended downwards to the bones of the leg, 

 and included also the whole of the left os 

 innominatum ; the anterior spines and crest of 

 the ilium were inverted, the internal iliac fossa 

 was much deepened, and the external surface 

 of the ilium rendered more convex than usual. 

 The rami of the os pubis and ischium seemed 

 more attenuated and slender than those of the 

 opposite side, and the foramen ovale wider. 

 The circumference of the acetabulum of this 

 side included nearly as large a space as usual, 

 but the upper and outer portion of its brim or 

 its supercilium was deficient. This cavity was 

 shallow, its surface scabrous or uneven, and 

 was nowhere invested with cartilage; a flattened 

 surface above it marked the point of habitual 

 contact of the head of the femur and ilium : 

 the bone was not excavated in this situation to 

 receive the head of the femur, which was re- 

 tained here, as already mentioned, by liga- 

 mentous bands, which extended from this part 

 of the ilium to the external surface of the cap- 

 sular ligament. The femur, it has been satd, 

 was atrophied at this side and slender, but it 

 was of the same length as the opposite bone, 

 diminished only in the circumference of the 

 shaft. The axis of the head and neck was 

 directed from the shaft of the bone upwards 

 and inwards, but it was straighter, and its di- 

 rection was by several degrees more forward 

 than natural. 



As we have detailed this case merely as an 

 illustration of the congenital malformation of 

 the hip, and do not wish here to enter into 

 minute particulars as to the morbid appear- 



3r 



