798 



ABNORMAL CONDITIONS OF THE HIP-JOINT. 



situated, but instead of opening by its posterior 

 extremity into the rectum, its fundus was ele- 

 vated somewhat higher in the pelvis, and burst 

 into the vena cava. The late Dr. M'Dowel, in the 

 fourth volume of the Dublin Journal, says that 

 in two cases of hip-joint disease he had seen 

 several years since, the matter had passed into 

 the pelvis through the bottom of the acetabu- 

 lum, and there accumulated in such quantity 

 as to compress the bladder and cause retention 

 of urine, requiring the daily use of the catheter. 

 He also adds, that this route for the matter is 

 not uncommon, and in its progress that it may 

 form a tumour of considerable size by the side 

 of the rectum, and occasionally burst into the 

 cavity of this intestine. Sir A. Cooper men- 

 tions the latter occurrence in one instance. Dr. 

 M'Dowel adds, I had an opportunity of wit- 

 nessing it. Abscesses take their course from 

 the diseased joint into the pelvis, and open into 

 the vagina. Sir B. Brodie mentions a case of 

 this kind in a child aged 11 years; and in 

 Dr. Kirby's collection, which he presented 

 to the College of Surgeons, is a similar ex- 

 ample. Dr. M'Dowel, in the paper already 

 alluded to, observes that he is not aware of its 

 being recorded that an iliac abscess may result 

 from a caries of the hip-joint, yet in four cases, 

 he adds, I have found it to occur. The fluid 

 escaping through an opening on the inside of 

 the capsular ligament, passes upwards behind 

 the psoas and ascends into the iliac fossa, de- 

 taching the muscles from the bone. In such 

 cases we have considerable fulness in the groin, 

 which can be traced upwards behind Poupart's 

 ligament ; from the stretching of the filaments 

 of the anterior crural nerve more neuralgic pain 

 attends this case than we usually find in disease 

 of the hip-joint. The iliac vessels are dis- 

 placed, become flattened and adherent to the 

 sac ; from the compression of the vein much 

 more oedema of the limb is present than in or- 

 dinary cases. The ccecum or the sigmoid flex- 

 ure of the colon may be considerably displaced 

 or united to the sac.* Sometimes it passes 

 behind the vessels, and accumulating, it may 

 compress the bladder and rectum, which then 

 form the inner wall of the abscess. 



In a very interesting case of iliac abscess 

 which was treated in the year 1833 in the Rich- 

 mond Hospital, ulceration of a portion of the 

 ilium adhering to the wall of the abscess oc- 

 curred, and its contents, after being poured into 

 the abscess, escaped externally through a fistu- 

 lous opening near the spine of the ilium ; ulce- 

 ration also of the external iliac artery took place 

 about an inch and a half above Poupart's liga- 

 ment, and sudden death resulted from the 

 blood escaping in large quantity into the cavity 

 of the abscess. The preparation is preserved 

 in the museum of the Richmond Hospital. 

 The anterior and crural nerves are often found 

 on the stretch. We have already mentioned a 

 case of this kind, (Clarke,) and Sir B. Brodie 

 mentions one in which he found two enlarged 



* The matter, which is generally prevented from 

 passing down into the true pelvis by the connexion 

 of the fascia iliaca, sometimes makes its way into 

 this cavity by ulceration of this fascia. 



lymphatic glands, each the size of a walnut, 

 immediately below the crural arch in the fore 

 part of the joint, and these lay in contact with 

 and immediately behind two branches of the 

 nerves, so as to keep the latter on the stretch, like 

 the strings passing over the bridge of a violin. 



We must not forget that the diseased action 

 in these cases of chronic strumous arthritis is 

 not confined to the joint. We have seen ex- 

 amples in the living and specimens in mu- 

 seums, proving that at the same lime both hip- 

 joints may be engaged in the same individual. 

 In acute cases we have given an example of the 

 membranes of the brain having been affected, 

 so also in chronic cases; tubercles have also 

 been found in the lungs, the mesenteric glands 

 extensively enlarged, and ulcers in the intes- 

 tines, and tubercular accretions in the perito- 

 neum. 



3. Chronic rheumatism. (Morbus coxa 

 senilis, or chronic rheumatic arthritis of the 

 hip.) By these terms we would wish to de- 

 signate a very peculiar disease of the hip- 

 joint, the morbid results of which are now pretty 

 well known: to pathological anatomists ; but it 

 must be confessed that very little has been 

 done to make the profession acquainted with 

 its symptoms or appropriate treatment. 



History of the disease. We will venture to 

 assert that there cannot be a more graphic il- 

 lustration given of this disease and its conse- 

 quences than those to be found in the Museum 

 Anatomicum of Sandifort, who has not confined 

 his delineations to the head and neck of the 

 thigh-bone, but has also shewn the various 

 alterations of form which the acetabulum un- 

 dergoes.* For many years this disease has 

 been accurately described in the clinical lec- 

 tures delivered in the different hospitals in 

 Dublin, and the importance of distinguishing 

 it from the other affections of this articulation 

 has been pointed out. Mr. Benjamin Bell, in 

 his work on the bones, has, under the head of 

 " interstitial absorption of the neck of the 

 thigh-bone," alluded to this disease, and detailed 

 many of its external signs, as well as the mor- 

 bid changes which the neck of the bone suffers ; 

 and in the sixth volume of the Dublin Journal, 

 Mr. Smith, in a paper on the diagnosis of in- 

 juries of the hip, has given a very good and 

 concise account of this remarkable affection of 

 the hip-joint. 



The writer of this article long ago, in his 

 lectures, gave the name of morbus coxa seni- 

 lis to the disease in question, but as he has 

 since met with many instances of it occurring 

 so early as at the age of thirty or forty, he is 

 now disposed to substitute for this name that of 

 chronic rheumatic arthritis of the hip-joint, 

 and he considers it as the same disease pre- 

 cisely as he has elsewhere in this work described 

 as affecting other articulations. (See ELBOW, 

 HAND, KNEE, SHOULDER.) 



As to the cause of this chronic disease of the 

 hip-joint, we believe little is known. We 

 have heard it frequently attributed to the effects 

 of cold and wet ; and an acute attack of rheu- 



* Mus, Anatom. Lugduni Batavorum, 1793. 

 vol. ii. tab. Ixix. ad Ixxiii. 



