ABNORMAL CONDITIONS OF THE HIP-JOINT. 



799 



matic arthritis of the hip-joint produced by 

 cold, we can easily conceive may occasionally 

 merge into the chronic affection we wish to 

 describe. We have also reason to think that 

 falls upon the great trochanter have given rise 

 to the first symptoms of this disease ; but in 

 many cases no satisfactoiy cause can be assigned 

 by the patient for the origin of the affection. 



Symptoms, SfC. The patient complains of 

 stiffness in the hip-joint and about the great 

 trochanter; also of a dull boring pain which 

 extends down the front of the thigh to the 

 knee. The stiffness is most felt in the morning 

 when the patient commences to walk ; but 

 after exercise the movements of the joint be- 

 come somewhat more free. In the evening 

 of a day the patient has had much walking 

 exercise, the pain is always more severe. The 

 uneasiness, however, gradually subsides after 

 he has retired to bed. The pain is always in- 

 creased when the patient throws the weight 

 of his body fully on the affected joint. But 

 let the surgeon press on the great trochanter, 

 or adopt any other expedient so as to push the 

 head of the bone even rudely against the ace- 

 tabulum, and these manoeuvres are the sources 

 of no uneasiness whatever to the patient. Al- 

 though we can easily satisfy ourselves that no 

 actual anchylosis exists, still it is evident 

 enough that the motion of rotation is lost, and 

 that the other movements, particularly flexion, 

 are confined within very narrow limits. When 

 we place the patient in a horizontal position, 

 and endeavour to communicate any of these 

 movements to the hip-joint, the patient com- 

 plains of pain, and an evident crepitation can be 

 heard and felt deep in the articulation. The limb 

 is apparently shortened by from two to three 

 inches ; the apparent shortening arises from the 

 obliquity of position of the pelvis relatively to the 

 spine, and the elevation of the affected side is 

 such that the crest of the ilium and the last short 

 rib approach nearer to each other at this side 

 in the ordinary attitude of standing by two 

 inches than those of the opposite side. All 

 these circumstances account for the apparent 

 shortening of the limb, which however, on 

 accurate measurement, will be found not to be 

 really shortened more than an inch. The patient 

 walks very lame, and with the foot and whole 

 limb greatly everted. The nates of the sound 

 side is unusually prominent, while that of the 

 affected side is quite flat, and no trace of the 

 lower fold of the glutseus is seen. The mus- 

 cles of the thigh also seem somewhat atrophied, 

 still they do not want for firmness ; and we 

 may uniformly observe that the calf of the leg 

 of the affected limb is not inferior in size and 

 firmness to the other. When we minutely 

 examine the great trochanter, we find it larger 

 and more prominent than usual ; and about the 

 situation of the acetabulum, horizontal branch 

 of the os pubis, and lesser trochanter, bony pro- 

 tuberances can, upon careful examination, be 

 recognized. This disease, when once fully esta- 

 blished in the hip-joint, rarely or never extends 

 itself to the other articulations. We have 

 known, however, a few examples in which it 

 affected both hip-joints in the same individual. 



The chronic inflammation of the various struc- 

 tures of the joint in which the disease consists, 

 is never accompanied by any appreciable de- 

 gree of heat or external swelling of the soft 

 parts, and we have never heard of the inflam- 

 mation going on to suppuration. 



The following case will shew the necessity 

 of making the profession fully acquainted with 

 this disease, as it proves how very obscure are 

 the early signs of the affection, and that even 

 the morbid appearances may be confounded 

 with those which are the result of accident. 

 At the meeting of the British Association in 

 Dublin, in the year 1836, one of its most dis- 

 tinguished members, Mr. Snow Harris of Ply- 

 mouth, made the following communication to 

 the medical section : " Sir A. Cooper and 

 many other eminent surgeons had doubted the 

 possibility of union taking place in fracture of 

 the neck of the thigh-bone, within the capsular 

 ligament. A case had lately fallen under his 

 (Mr. H.'s) notice, which he thought would 

 tend to set the question at rest. It was that of 

 a gentleman who had received an injury by 

 being thrown from his gig ten years ago. He 

 had got up and walked immediately after the 

 accident, but continued lame from that period 

 up to the time of his death. He had been at- 

 tended by some of the most celebrated surgeons 

 in London, but they had not been able to de- 

 termine whether there was a fracture of the 

 bone or not, but kept him lying on a sofa for 

 nearly twelve months. The injured limb was 

 shortened, the foot everted, the thigh wasted, 

 and owing to the constant inclination of the 

 body forward on one side, a lateral curvature 

 of the spine took place. Some time ago the 

 gentleman died of disease of the heart; and 

 Mr. Harris, being anxious to examine the 

 parts, removed the acetabulum and a portion of 

 the thigh-bone, which he then presented for 

 the inspection of the meeting. He had found 

 the trochanter higher up than natural, and the 

 neck of the bone shortened ; a section of the 

 bone had been made, and the line of union, in 

 Mr. Harris's opinion, was clearly manifest." * 



When Mr. Harris exhibited this specimen to 

 the medical section of the British Association 

 which met in Dublin, it excited much interest, 

 first as the individual, the subject of the case, 

 was the celebrated comedian Mr. Matthews, 

 and secondly, as at the announcement of the case 

 it was asserted that it settled in the affirmative 

 the much agitated question, whether the intra- 

 capsular fracture of the cervix femoris was or 

 was not susceptible of osseous union. The 

 writer was present at the communication of this 

 case to the section, and upon the presentation 

 of the specimen expressed his doubts that this 

 case, either from its history or post-mortem 

 appearances, was an example of the intra-cap- 

 sular fracture, and rather held the opinion that 

 it was one of this chronic rheumatic affection 

 which he has been endeavouring to describe ; 

 in which opinion he was most decidedly con- 

 firmed upon inspecting the acetabulum, the 

 widening of this cavity, the complete filling up 



* See Dublin Journal, vol. viii. 



