428 Diseases of Joints. 



7. 8. Suppurative Osteo-Myelitis of the Femur, involving- 



Hip-joint.— Left innominate bone and upper end of femur 

 of a young person — macerated, illustrating the above. 



The angle which the neck of the femur forms with the shaft 

 is very obtuse. At and below the level of the small trochanter 

 the bone is irregular in shape and condensed, while, on the front 

 of the head and neck and great trochanter, the bone is greatly 

 rarefied (carious), and the articular surface of the femur in 

 many places is rough and bare. Below the outside of the great 

 trochanter a sinus runs upwards into the bone. 



This condition has all the appearance of having begun as 

 an acute osteo-myelitis of the upper end of the shaft. The 

 disease has evidently involved the hip-joint, producing rare- 

 factive ostitis in the head and neck, and has led to new bone 

 formation below the level of the trochanter. G. C. 631. 



h. Where the pus-forming organisms have reached the joint directly 

 through wounds. 



7.9. Septic Inflammation of the Hip-joint. — Upper end of 



a left femur, with the soft parts outside the joint dissected off 

 —in spirit, illustrating the above. 



Tlie patient, a young man, had been treated in the Royal Infirmary, 

 Edinburgh, for a large abscess in the left inguinal region, above the 

 situation of the inguinal ring. This was opened, and much matter was 

 discharged. He was beginning to improve, when seized with sudden pain 

 in the inside of his thigh and knee. Symptoms of septic absorption, 

 indicated by fever, sweating, and afterwards delirium, came on, and 

 he died exhausted in about a fortnight. 



This was probably a psoas abscess, which had pointed in the 

 abdominal wall, and after having been opened, had turned septic and 

 communicated with the hip-joint. 



" The ligamentum teres was absorbed, and the cartilage 

 covering the head of the bone, and also that lining the 

 acetabulum, could scarcely be said to exist." The greater part 

 of the bone is bare of cartilage, and the bone below is rarefied. 



G. C. 1101. 



PrescntccJ by Sir Geouge Ballingall. 



