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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    81 in saying that the term is a misnomer. There is no congenital dislocation, hut an arrest ot' the development of the acetabulum, the bone having never been completed. It is a congenital displacement, from an arrest of develop- ment, but not a congenital dislocation. The dislocations that occur in the adult are immediately recognized and attended to, and alter reduction the parts are kept at rest until all danger of inflammation has passed; whereas the slight injuries which cause hip disease in the child are overlooked, and atten- tion is not called to them until, by continued irritation, inflammation has supervened; and the general health frequently becomes involved before the slight local injury is recognized. Moreover, in the adult the head of the femur is much less vascular than in the child. Dr. Kingston said:—We are told that hip-disease may originate from in- juries to the cartilage and bone, and also from ruptures or injuries of the liga- mentum teres. Now, I am wholly prepared to admit that in the first set of cases local treatment would probably suffice to effect a cure, but I wish to know if the same degree of probability applies also to cases originating in lesions of the ligamentum teres? Dr. Sayre said:—I can answer that question by a practical illustration. Five or six years ago a case of coxalgia was brought to me by Dr. Jourdon for excision. There was an open abscess, which had gone through all the various stages, the disease having originated from a blow two and a half years before. At the time I saw the case the child was hardly in a condition in which it was deemed advisable to operate, and so I thought it better, in order to save the child, to get it in a better condition. In the mean time, to make the child as comfortable as possible, and put it in a condition for treatment, I brought it out of its surroundings, and got it out of doors to build it up a little. When the time came for the operation, the child was so much better that I concluded to give it a chance without excision. I made a free incision into the joint, and took away a comparatively small portion of the bone only. Repair took place; the child got entirely well; and ran around a year and a half without any splint, and with only slight deformity, and with a tolerable degree of motion. Some year and a half ago, through exposure, the child got into a very bad condition, and the physician in attendance informed Dr. Jour- don that it was going to die. The child did die, and I have the specimen. The head of the femur and the ligamentum teres have entirely disappeared ; a new covering had been formed, of what I do not know, but it was smooth, hard, and cartilaginous. So that that child lived two or three years without any ligamentum teres at all. Dr. Post said:—With regard to the necessity of resorting to excision, we all have known of advanced cases of the disease in which there has been a favorable result. I was called, two or three years ago, to see a patient in Jersey City. The knee was thrown up almost to the chin. It was impossible to place the child in a position even approximately straight, in consequence of the extreme pain which the effort gave him. He was almost ready to die from the constitutional disturbance attending the advanced stage of the disease. He was placed under the influence of ether, and the limb brought into as straight a position as possible. It was during cold weather, when there was a fire in the grate, and I put a poker in the fire, and made a thorough application of it behind the great trochanter. Improvement began from that time; and some time afterwards the child was brought to me free from deformity. Here was an entire recover}-, and this case goes to show that excision is not always absolutely necessary. Dr. Sayre said:—I have only advised the operation in cases in which the disease progresses in spite of proper treatment. Mr. Lister said:—I think that a distinction between the stage of effusion, and the stage of suppuration, would be more in accordance with the general pathology of the subject. I believe the last stage of hip-joint disease is inva- riably the stage in which suppuration is present. Where effusion exists