788 



ABNORMAL CONDITIONS OF THE IIIP-JOINT. 



opinion as to this case, we would cer- 

 tainly question much the correctness of the 

 conjecture, that the inflammation of the hip- 

 joint was altogether limited to the synovia! 

 membrane: no doubt, so far' as the hip was 

 concerned, the inflammation began in the syno- 

 vial structures ; but who can doubt that in this 

 case the cartilages became secondarily en- 

 gaged, that the acetabulum itself was after a 

 time implicated, and that an abscess had 

 formed ? For our parts, we have little doubt 

 that all the structures entering into the compo- 

 sition of the articulation were implicated in the 

 inflammation of the joint. 



It has been above stated, as the opinion of 

 the author now cited, that synovitis has for the 

 most part the form of a chronic affection, but 

 as a proof that a disease, apparently slight, 

 and of a part no way concerned in the vital 

 functions, may produce such a degree of dis- 

 turbance of the constitution as rapidly to occa- 

 sion death, he adduces the following case.* 

 Sir B. Brodie considers it a case of inflam- 

 mation of the synovial membrane, (synovitis 

 coxae,) which ran its course to a fatal termina- 

 tion in the short space of a week. 



A young lady, nine years of age, being at 

 play on the 1st of January, 1808, fell and 

 wrenched her hip ; she experienced so little 

 uneasiness, that she walked out on that day 

 as usual; in the evening she went to a 

 dance, but there was seized with a rigor, was 

 carried home, and put to bed. Next morning 

 she was much indisposed, and complained of 

 pain in the thigh and knee ; on the following 

 <lay she had pain in the hip, and was feverish. 

 These symptoms continued ; she became deli- 

 rious, and died just a week from the time 

 of the accident. On inspecting the body on 

 the following day, the viscera of the thorax and 

 abdomen were found in a perfectly healthy 

 state. The hip-joint on the side of the injury 

 contained about half an ounce of dark-coloured 

 pus, and the synovial membrane, where it was 

 reflected over the neck of the femur, was 

 destroyed by ulceration for about the extent of 

 a shilling. This was an awful case, and such, 

 fortunately, are rare ; however it has been our 

 lot to witness some very similar in their course 

 and unhappy termination, and we have always 

 looked upon them as specimens of that terrible 

 disease " diffuse inflammation." 



The next case, No. XVI. in Sir B. Brodie's 

 work,f we look upon exactly in the same light. 

 The following the writer saw under the care of 

 his lamented friend, the late Dr. M<Dowel. 



Synovitis coxa with periostitis succeeding to 

 fall on the hip death in eight days. Peter 

 Neale, set. 12, admitted into the Richmond 

 Surgical Hospital, January 11, 1833. Four 

 days previous to admission he fell from a wall 

 of moderate height, on the left hip, which was 

 so much contused, that he was unable to stand 

 upon the limb, and was carried home. The 

 pain and constitutional disturbance increased 

 daily; on admission it was found that the left 



* Case XV. p. 64, 3d edit, 

 t Page 6~5, 3d edition. 



hip-joint was very tense and swollen ; the pain 

 was so excruciating that he was unable to move 

 in bed without assistance; his countenance 

 anxious, sunken, and expressive of intense suf- 

 fering, tongue furred, black sordes on his teeth ; 

 he was delirious, and screamed without inter- 

 mission ; his hip became more tender, tense, 

 and swollen ; he also now complained of pain 

 in the right shoulder and elbow. To these 

 symptoms succeeded drowsiness, tendency to 

 coma, occasional muttering delirium ; he now 

 had a peculiarly wild and frightened look. 

 He died on the morning of the 15th ; the 

 fourth from his admission into the hospital, 

 and the eighth from the time of the fall on the 

 hip. The post-mortem examination took place 

 four hours after death. On cutting through the 

 left glutaeal muscles, matter issued from nu- 

 merous small points ; the muscular fibres were 

 of a deep red colour ; the periosteum was de- 

 tached from the entire of the ilium by a quan- 

 tity of dark brown pus, which passed through 

 the great sciatic notch, and separated the mem- 

 brane from the whole concavity of the bone, 

 which was of a pink colour ; the fluid had 

 passed through a small ulcerated opening in 

 the capsule of the joint from the cotyloid 

 cavity; small portions of lymph were found on 

 the head of the bone, and the synovial mem- 

 brane, covering the fatty mass at the bottom of 

 the acetabulum, bore evidences of acute inflam- 

 mation having existed here ; and the surface of 

 the synovial membrane was also covered with 

 lymph. There was no ulceration of the carti- 

 lages. The right shoulder-joint healthy. In 

 the right elbow-joint a fluid in small quantity, 

 resembling that which was contained in the 

 hip- joint.* 



Cartilage. The inflammation and ulcera- 

 tion of the cartilages of the hip-joint are said by 

 Sir B. Brodie to be most frequently met with 

 in those who have passed the age of puberty, 

 and who are under thirty or thirty-five ; but 

 that they are sometimes seen in young children, 

 and occasionally in those advanced in life : 

 when the cartilage covering the bones which 

 enter into the articulation of the hip-joint are 

 affected, the progress of the case is slow; the 

 pain is at first trivial, the degree of lameness 

 slight; but as there is no effusion of pus or 

 increased secretion of synovial fluid, there is no 

 appreciable external swelling; but the pain, 

 the wasting of the limb, and lameness gra- 

 dually increase, with the spasmodic startings, 

 and abscess and dislocation follow, as in cases 

 in which the inflammation originated in other 

 tissues. To exhibit the disease of the cartilage 

 where this structure alone is engaged, we must 

 have some opportunity of witnessing it in an 

 individual who has died of some other com- 

 plaint. The following case well illustrates the 

 opinion of the first authority on such a sub- 

 ject. 



John Catmah, 44 years of age, was admitted 

 into St. George's Hospital on the 29th of Sep- 

 tember, 1813, with pains of the lower limb of 



* See Dr. M'DowelY observations in the 3d and 

 4rh volume of the Dublin Journal, on Synovitis, r. 



