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)

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    rest, low diet, and moderate antiphlogistic treatment should be adopted. By this plan reaccumulation very rarely takes place, but, if it should, the operation may be safely repeated if necessary, as has been done in two or three instances. Goyrand's method as applied to the hip-joint, differs but slightly from the one just described. A two-edged small knife is used like the trocar, inserted in the same place and manner into the joint, and an opening of the capsule made for about half an inch, and finally its contents driven into the cellular tissue in the same man- ner as above described, by changing the position of the limb and the same after-treatment observed. If the puncture of the joint reveals the fact that the fluid is already purulent in its character (which might have been clinically ascertained before by a careful analysis of the constitutional symp- toms), the question rises whether this pus. is simply the product of synovitis, or, whether it is connected with the ulceration of the cartilage and caries of the bone. The former has been disputed, but erroneously so, for synovial membranes, like other serous mem- branes, are susceptible of suppuration without ulceration, the epithelial cells being simply converted into parental pus cells, as proven by Haidenhein. With very few exceptions, when there is ulceration of cartilage and bone, we find more or less crepitus, and this can be clearly ascertained by rotation of the affected limb after the fluid has been withdrawn. In the absence of crepitus, and especially if the disease is of but short duration, we are justified in premising that the case is simply suppuration of the synovial membrane, and hence allow the patient the chance to recover without any further operative procedure. Analogy teaches us that synovial membrane in a state of simple suppuration may, like serous membranes, recover its integrity by the evacuation of its morbid products, in proof of which we need only to refer to Dr. Bowditch on Empyema. I therefore treat this punctured wound as already stated, ivhen it was simply organ- izable lymph, and rather repeat the operation in case of reaccumula- tion, than to leave it open by a free incision. If we, however, satisfy ourselves of the fact that the articular surfaces have become ulcerated, the cartilages disintegrated and partly detached, the bones corroded, which can be ascertained with- out difficulty by the crepitus which is peculiar to itself, and alto- gether different from the crepitus of healthy bone, we consider the