Report on morbus coxarius, or hip disease / by Lewis A. Sayre.

  • Sayre, Lewis A. (Lewis Albert), 1820-1900.
Date:
1860
Catalogue details

Licence: Public Domain Mark

Credit: Report on morbus coxarius, or hip disease / by Lewis A. Sayre. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    19/112 (page 11)
    sion, gradual and slight, but constant, for a little while, relieves it almost entirely. It is a remarkable fact, that the synovial membrane when in a healthy state, in common with all serous membranes, possesses no sen- sibility whatever, and will bear pressure of the severest kind, with- out the least sensation of pain, as is proved by jumping from great heights and striking upon the heels, producing no pain whatever. Yet when this membrane is inflamed, the slightest amount of pres- sure produces the most intense suffering, as we also find in pleu- ritis, peritonitis, &c; and hence the necessity of removing all pressure from thi3 delicate and sensitive membrane when in a state of in- flammation. Second Stage.—This inflammation, unless arrested, will readily produce effusion, and if this be of much amount, it will produce a peculiar deformity, viz., an apparent elongation of the limb; eversion and abduction; flattening of the natis; the rima natis on the dis- eased side being lower than on the sound side; flexion of the thigh on the pelvis, and the leg slightly flexed upon the thigh. If the effusion be excessive, or the inflammation acute, you will have an apparent anchylosis, caused by muscular contraction, which is an involuntary act, produced by reflex action of the inflamed or irri- tated nerves, and is done for the purpose of keeping the joint perfectly still. It affords the natural indication for the surgeon by imitating this action, to accomplish the same result, of perfect rest to the in- flamed synovial membrane. This we may do in a much more effec- tual manner, for at the same time we succeed in relieving the other parts from a pressure which, if long continued, must cause, in the absorption of the cartilage and bone, the destruction of the joint. Motion, when not accompanied by extension, is much more painful than rest, even if accompanied by the pressure caused by the mus- cular contraction. Hence the patient, naturally choosing the least of two evils, obtains rest of the part by muscular rigidity, even at the expense of the absorption arising from the pressure, as well as of the hectic and exhaustion caused by this constant muscular effort. The flexor muscles of the thigh, the tensor-vaginae femoris, the pectineus, and rectus-femoris, are so firmly contracted that the whole pelvis moves on the opposite acetabulum; in short, the ilium of the opposite side may be distinctly seen to move upon any attempt to rotate, adduct, or abduct, the diseased limb. Even under chloro-