794 



ABNORMAL CONDITIONS OF THE HIP-JOINT. 



rates at its epiphysis from the neck of the bone, 

 and the latter is drawn up, (Jig- 311,) and the 



Fig. 311. 



whole limb shortened greatly, and the toes are 

 as much everted as when fracture of the neck 

 of the femur occurs from accident. The short- 

 ening is usually, but not invariably, the pre- 

 cursor of abscess; when this occurs, the disease 

 is in its fourth stage. This period, or that of 

 of the formation of matter, is generally marked 

 by an aggravation of the pain, by frequent 

 spasms and starlings of the muscles, by greater 

 wasting of the limb, occasional oedema of the 

 foot, (which is a very unpromising feature,) 

 &c. These chronic symptomatic abscesses may 

 present themselves in various directions ; the 

 matter may remain for months without under- 

 going any change, and even after this be rather 

 suddenly absorbed, or the pus may escape 

 through openings made by nature or by art ; 

 the external orifices of these abscesses frequently 

 degenerate into fistulae, from which exfolia- 

 tions occasionally take place, and these exfolia- 

 tions are sometimes so small as to be almost sabu- 

 lous, sometimes larger pieces come away with 

 pain ; such are to be considered not unfavoura- 

 ble indications. The writer has known two ex- 

 amples of the head of the femur thus separated at 

 their epiphysis from the neck of the bones ; in 

 these cases the patients recovered, with the usual 

 deformity.* Of the numerous situations around 

 the hip-joint, in which matter has been found 

 deposited, there is one variety which demands 

 the special attention of surgeons, in conse- 

 quence of the difficulty which has been expe- 

 rienced in recognizing the disease, namely, the 

 case in which the caries affects the bottom of 

 the acetabulum, so that the fundus alone is de- 

 stroyed. Sir B. Brodie met with one case, 



* One of these was presented to him by Mr. 

 Shaw, the surgeon to the Clonard Dispensary, and 

 is preserved in the Richmond School Museum ; the 

 other was shewn by Dr. Carlile lately to the Patho- 

 logical Society, Dublin, 



where in the bottom of the acetabulum there 

 was an ulcerated opening, just large enough to 

 admit a common probe, communicating with 

 an abscess within the pelvis. Mr. Tagart* 

 alludes also to a case in which this perforation 

 exists. ( Figs. 312 and 313.) Of such per- 



Fig. 312. 



* Lancet, vol. i. 1835 and 6, Jan. 2. 



