3i 8 Anatomy Applied to Medicine and Swgety. 



in speaking of the change from the first to the second, 

 says, "The cause of this change is quite occult. At pre- 

 sent we are without any clue even to an inference as to its 

 nature." 



With the rjosition of the limb in the first stage there is 

 necessarily associated apparent lengthening. This is due 

 to the position of abduction present in this stage, for, 

 should the patient be asked to bring his limbs parallel, 

 when lying down, or to touch the ground with the foot of 

 the diseased side, when standing, he will have to lower 

 down the pelvis on the affected side so as to bring the 

 abducted limb to a parallel or to a vertical position. In the 

 second stage there is apparent shortening, because of the 

 adduction present, since here, as in the first stage, the 

 patient alters the transverse axis of the pelvis to make the 

 limbs parallel, and this alteration consists in raising, or 

 tilting up, the side of the pelvis corresponding to the 

 affected limb, so that the latter is apparently shortened. 

 In either stage, a change in the direction of the spinal axis 

 must, also, occur, when the patient attempts to bring the 

 limbs into a parallel position. This is due to the fact that, 

 since the limb is fixed in a flexed position, it is impossible 

 to straighten it by means of any movement at the hip joint, 

 and further, that the amount of movement permitted at 

 the sacro-iliac joint is not sufficient to allow the limb to be 

 straightened, so that, to straighten the limb it will be ne- 

 cessary to extend it by lor do sis, i.e., by a forward bending 

 of the lumbar vertebrae. Limping, in morbus coxge, is 

 dependent, probably, on the fact that "the weight of the 

 body on the femur causes uneasiness, hardly amounting 

 to pain, but sufficient to lead the patient to rest as short a 

 time as possible on the limb, and there is, therefore, a 

 short step and a long one alternately" (Treves). 



