ABNORMAL CONDITIONS OF THE HIP-JOINT. 



787 



Fig. 309. 



grew to the cotyloid ligament at the notch, as 

 is usual, and had no other connexion with the 

 acetabulum, which contained no Haversian 

 gland, and was not lined by cartilage. The coty- 

 loid ligament was very flat and imperfect. 



Bones. In the general aspect of the bones 

 of the pelvis and of the femur, there existed a 

 very striking resemblance between this case 

 and the former detailed. The os innominatum 

 of the left or deformed side, together with the 

 femur and other bones of the left lower ex- 

 tremity, were much smaller than the os inno- 

 minatum and bones of the right lower ex- 

 tremity ; the former, besides being deformed, 

 were also in a state of atrophy in circumference 

 and length, while the latter were evidently larger 

 and better nourished than one would expect to 

 find them in so delicate an individual. In a 

 word, there was a compensatory growth of the 

 skeleton on the right side, as it were to make 

 up for the deficient growth of the left or mal- 

 formed side. The head of the right femur and 

 the corresponding acetabulum were both very 

 large, the right half of the pelvis too, in all its 

 bony prominences, was well marked, and the 

 anterior spines of the ilium were inverted ; the 

 inter- vertebral substance intervening between 

 the last lumbar vertebra and base of the sacrum 

 was much thicker than usual. 



SECTION II. Disease. The abnormal ap- 

 pearances we notice in the articulation of the 

 hip, produced by disease, are usually the result 

 of inflammation, which may have been either 

 acute or chronic ; arising either in the synovial 

 membrane, the cartilage, or the bone. Indeed, 

 in modern works on the diseases of the joints, 

 we have laid down for us rather positively the 

 symptoms and anatomical characters of syno- 

 vitis, chondritis, and osteitis ; but much as we 

 would wish to adopt an arrangement that the 

 pathology of Pinel and Bichat would suggest, 

 and which comes commended to us by the ex- 

 perience of Brodie, we do not think that this 

 arrangement can be strictly adhered to. In 

 acute rheumatic arthritis, we have the synovial 

 or fibro-synovial structures of the articulation 

 engaged, with little, if any, implication of the 

 cartilage or bone, but in any of the cases com- 

 monly denominated " disease of the hip," the 

 inflammation, as far as our experience has gone, 



never long confines itself to any one structure 

 entering into the composition of the joint. In 

 a work, however, like this, the opinions of the 

 highest authorities on such a question must be 

 quoted . According to Sir Benjamin Brodie,* 

 synovitis coxae, or inflammation of the syno- 

 vial membrane of the hip-joint, may take place 

 in different degrees of intensity ; but for the 

 most part it has the form of a chronic or slow 

 affection, which, while it impairs, does not de- 

 stroy the functions of the articulation. In the 

 hip, less frequently than in other joints, is the 

 fluctuation of the effused fluid perceived, but 

 the existence of swelling is sufficiently evident 

 beneath the muscles : there is fulness of the 

 groin and pain, which is not " referred to the 

 knee, as in cases of ulceration of cartilage, but 

 to the upper and inner part of the thigh, im- 

 mediately below the origin of the adductor 

 lougus ; the weight can be borne on the af- 

 fected limb, and pressure against the heel gives 

 no pain ; this (the pain) is often severe, yet it 

 does not amount to that excruciating sensation 

 which exhausts the powers and spirits of the 

 patient, in whom the cartilages of the hip are 

 ulcerated." 



The following case Sir B. Brodie adduces as 

 an example of inflammation of the synovial 

 membrane of the hip, terminating in disloca- 

 tion. 



Master L.,f being at that time about eight 

 years of age, was attacked towards the end of 

 September, 1824, with what was believed 

 at the time to be inflammation of one of 

 the parotid glands, attended with a good deal 

 of fever ; after six or seven days, and appa- 

 rently in consequence of the application of 

 cold lotions to the cheek, the inflammation left 

 the parotid gland, and attacked one shoulder and 

 arm ; and at the end of two or three days more 

 it left the shoulder and attacked one of the hips. 

 For six or eight weeks he suffered most severely 

 from pain referred to the inside of the thigh, 

 extending from the pubes as low down as 

 within two or three inches of the inner con- 

 dyle of the femur, and attended with a great 

 deal of fever. There was no pain in the knee. 

 The surgeon who was then in attendance ap- 

 plied leeches to the hip, lotions, &c. &c., and 

 afterwards made an issue with caustic behind 

 the great trochanter. The fluctuation of fluid 

 was perceived at the posterior part of the hip ; 

 and it was supposed that an abscess had 

 formed ; however, no puncture was made, and 

 the fluid gradually became absorbed. In 

 March, 1825, Master L. was sufficiently well 

 to be able to walk about, but it was discovered 

 that the limb was shortened. In November, 

 1825, Sir B. Brodie was consulted respecting 

 him ; at this time there were all the marks of a 

 dislocation of the hip upwards and outwards, 

 the limb was shortened, the toes turned in- 

 wards, and the head of the femur was distinctly 

 to be felt on the posterior part of the ilium, 

 above the margin of the acetabulum. 



Now, if we may be permitted to give an 



* On Diseases of the Joints, 3d edit, 

 t Case XI. Brodie, page 51, 3d edition. 

 3F 2 



