ABNORMAL CONDITIONS OF THE HIP-JOINT. 



795 



forations the writer has seen in different mu- 

 seums a great variety: in many instances the 

 opening is small, in others of sufficient size to 

 admit easily the head of the femur. These 

 cases are in the beginning obscure, and when 

 abscesses form, they are concealed within the 

 cavity of the pelvis. 



Anatomical characters. When opportuni- 

 ties have occurred of examining the interior of 

 the hip-joint in those who hare died of other 

 complaints, this articulation being, at the time 

 of death, in the early stages of the chronic dis- 

 ease we are now considering, the adipose 

 cellular mass which occupies the fundus of the 

 acetabulum, the cellular structure which con- 

 nects the fibres of the inter-articular ligament, 

 the subsynovial cellular tissue which surrounds 

 the corona of the head of the femur, as well as 

 the interior of the bones themselves, have been 

 found to wear an unusually red appearance 

 from increased vascularity. The cartilage has 

 been found softened, to have lost its usual 

 lustre, to be slightly elevated, and too easily 

 torn from the subjacent bone ; in some cases 

 thinned, in others detached in flaps; in some 

 it has presented a corroded appearance, and 

 coinciding with these changes purulent matter 

 has been found in the interior of the joint, the 

 capsular ligament thickened, and the lymphatic 

 glands in the groin enlarged. In the anatomi- 

 cal examination of those who have died in the 

 advanced stages of the scrofulous disease of the 

 hip, if the patient have not arrived at the age 

 of puberty, we find that very frequently the 

 original portions of the os innominatum are 

 separated from each other for several lines, that 

 the epiphysis of the head of the femur is com- 

 pletely detached from the shaft of this bone ; 

 the greater and lesser trochanters are sometimes 

 in very young subjects removed by absorption, 

 and evidence of devastating caries is found in 

 the bottom of the acetabulum. ( Fig. 311.) 



In some cases the head of the bone has been 

 found dislocated on the dorsum ilii, previous 

 to which occurrence all the ligaments have been 

 destroyed, the acetabulum has the superior and 

 posterior part of its brim removed by caries, 

 and the bone thus abandoned to the action of 

 the muscles takes the position it ordinarily 

 does in the common luxation upwards and 

 backwards on the dorsum ilii. This complete 

 dislocation is not so common an occurrence as 

 generally imagined ; there are, however, some 

 specimens of it preserved in the museum of the 

 College of Surgeons in Dublin. In one pre- 

 paration, the cartilage of the head of the femur 

 is perfect, the round ligament is gone ; the fur- 

 ther ascent of the head of the bone on the dor- 

 sum ilii seems principally restrained by the ob- 

 turator muscles (Jig. 314). The interesting 

 circumstance in the preparation to be noticed 

 is, that the acetabulum is occupied to the level 

 of its brim with a very dense atheromatous 

 matter or yellowish green lymph, apparently an 

 unorganized substance resembling what we see 

 contained in crude scrofulous tubercles : what 

 remained of the capsular ligament around the 

 neck of the femur has been cut crucially, and 

 the everted edges of the flaps shew th thick- 



Fig. 314. 



ness of this ligament, increased to four or five 

 lines, and caused by the interstitial deposition 

 of something like atheromatous matter. 



We have in the foregoing pages alluded to 

 the different directions in which the head of the 

 femur has been found dislocated in the third or 

 fourth stage of this disease, and should here 

 state the anatomical characters of each luxation, 

 but we have not facts to guide us in the de- 

 scription. 



When a section is made of the bones enter- 

 ing into the composition of the hip-joint, when 

 the patient has died of this disease in an ad- 

 vanced stage, they will be found to be softened 

 in the interior, and to contain a fatty or a yel- 

 lowish cheese-like matter in their cells ; when 

 opportunities have occurred for examination in 

 an earlier stage of this scrofulous caries, these 

 organs have been generally found preternatu- 

 rally red and vascular, (as before stated,) with 

 a deficient proportion of earthy matter, admit- 

 ting not only of being cut with a knife without 

 turning its edge, but yielding and being crushed 

 under very slight pressure. A modem au- 

 thor,* after quoting the authority of Lloyd on 

 scrofula as proof of the truth of some of the 

 foregoing observations, adds his own opinion, 

 " that in simple inflammation, uninfluenced by 

 the scrofulous diathesis, particularly when it 

 becomes of a chronic character, bone is secreted 

 in abundance, but that the striking feature 

 in this kind of inflammation is, the absence of 

 all secretion or deposit of bone." With the 

 latter doctrine we cannot at all agree, and must 

 conclude we do not rightly apprehend the 



* Coulson on the Diseases of the Hip-joint, 

 Loud. 1837, 4to. p. 39. 



