When an abscess appears upon the surface as a tumefaction merely, with no other evidence that it is an abscess than that it is associated with hip-joint dis In the tubercular hip-joint disease early and complete excision strongly recommended. Arthur E. Barker (Brit. Med. Jour., Jan. 19, '89).
Tubercular abscesses in the course of hip-joint disease to be treated on true surgical principles: free incision, thor ough curetting of the walls of the abscess-cavity while the wound is being flushed with plain boiled sterile water, and complete closure of the wound in the skin without drainage. W. J. Taylor (Annals of Surg.. July, '95).
ease, to excise and subject the patient to further danger of pyogenic infection would be anything but good treatment. S. L. McCurdy (Med. and Surg. Reporter, Feb. S, '96).
If there has been a mixed infection grafted on top of the original tubercular focus, immediate operation with free in cision of the abscess, complete removal of all debris, and thorough drainage should be employed. As a usual thing, the abscess has originated in the bone, and in the cavity will be found very fre quently some crumbs of dead bone, al though occasionally they are not present, while not infrequently, in cases opened at an advanced stage, the abscess seems to have been shut off from the original bone-focus, which has healed up after extruding its carious bone. Many cases pass on to abscess quite promptly, and, indeed, it sometimes seems as if those cases which suppurated early and ran an acute course got well in shorter time than those which were accompanied with less pain and less suppuration. The oc currence of abscess does not necessarily mean a less favorable result, and it is not unusual to see cases of double hip dis ease, one side having been the seat of an abscess and the other having been free from suppuration, in which the motion is better on the side where suppuration took place.
If great destruction of the head of the femur or the acetabulum are present when the case first comes under observa tion, or if, in spite of protection and good hygienic surroundings, the case does not do well and disintegration of the joint is progressing, the question of excision pre sents itself. And here again the difficult
problem is when to operate and when not. The great majority of cases, seen in the early stages and properly treated, never reach the point of operation, ex cept in the class of acute infectious osteo myelitis. And, again, there are other cases which come to the surgeon, with grave hectic symptoms, a hip full of bur rowing sinuses, and a mass of dead bone inclosed in a thick involucrum, which have no chance for life except by the prompt removal of all diseased tissue and proper drainage.
[Number of eases of resections of the hip recovered with very good motion. One has almost perfect motion; can run, dance, skate, and walk many miles with out the slightest fatigue, although more than 3 inches of his femur and much of his acetabulmn were removed; yet he has only inch shortening of the limb. LEWIS A. SAYRE, Assoc. Ed., Annual, '90.] Ultimate results in 66 cases of hip joint excisions (by cure is meant that all sinuses have closed, and there is no symptom of trouble about the hip; by relieved, that sinuses are open); There were 3'2 children discharged cured, 25 died, 3 discharged relieved, 2 discharged not improved, and 4 in the hospital.
Of the cause of death, 14 died from amyloid degeneration, 1 from amyloid degeneration and peritonitis, 2 from gen eral tuberculosis, 1 from acute nephritis, 1 from septicaemia, 1 from heart-failure, 1 from coma (uraunic), 3 from menin gitis, and 1 from exhaustion.
Of the patients discharged cured, the present condition of 23 is absolutely known: 1 is well 18 years after dis charge; 1 well 11 years after discharge; 2 well 9 years after discharge; 1 well years after discharge; 2 well 6 years after discharge; 1 well 5 years after dis charge; 1 well 4 years after discharge; 1 well 3 years after discharge; 4 well 2 years after discharge; 0 well 1 year after discharge. Poor (N. Y. Med. Jour., Apr. 23, '92).
Preparation of a hip-joint on which the writer had performed resection some years before. It demonstrated that the end of the femur had made a good mov able joint in the acetabulum. Not a bad fnnctional result obtained in one hun dred and fifty hip-joint resections. Schede (Deutsche med.-Zeit., May 22, '93).