The pathology and treatment of morbus coxarius / by Lewis A. Sayre.

  • Sayre, Lewis A. (Lewis Albert), 1820-1900.
Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: The pathology and treatment of morbus coxarius / by Lewis A. Sayre. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    as I have seen in cases in which the acetabulum has been perforated, making-their way between the internal periosteum and the ilium, and forming openings above the pubis; so that the third stage of hip-disease may be accompanied with external fistulous openings in various direc- tions, and with very great exhaustion from extensive suppuration. We are now prepared to study the treatment of morbus coxarius, which of course varies according to the stage in which we tind the disease ; and the reason that I have dwelt so particularly upon the diagnosis of the affection in its earlier stages, is because, as I have before stated, proper treatment at this time, in the great majority of cases, will be followed by perfectly satisfactory results. In the first stage of the disease, if the symptoms of inflammation be very acute, and pain and tenderness very great, absolute and 'perfect rest of the joint is most essentially requisite. In the hearty and robust patient, in vigorous health, leeches or cups, or some other form of local depletion, may be necessary ; ice bags, surrounding the joint, often afford the great- est possible relief, while in other instances hot fomentations, the exact opposite, will give the greatest ease. There is no rule with which I am acquainted, that will guide you in the application of heat and cold, except the feeling of the patient, and this can only be determined by a practical test. The remedy which gives the greatest relief, and is the most agreeable to the patient, is the one to employ. In addition to these local measures, extension (very slight, but continuous) in the line of the deformity, should be made by means of a weight and pulley, secured to the limb by strips of adhesive plaster, and a roller. The adhesive strips should always extend above the knee, to avoid traction upon this articu- lation. The pulley should be attached in some manner to the bed, the foot of which should be elevated ten or twelve inches, so as to make the body act as a counter-extending force. (See Fig. 8.) When the extension is first applied, the traction should be made in the line of the deformity, and the direction should be changed by slow degrees, day by day, until the limb is gradually brought into its natural position. It is sometimes necessary to apply a second extending power, at right angles to the limb, to remove the pressure of the head of the femur against the inner surface of the acetabulum. This is readily done by passing a handkerchief around the upper and inner part of the thigh, securing in its outer loop a cord to which is attached a weight playing over a pulley at the side of the bed. If the bowels are constipated, cathartics as a matter ot course are iudi-