Treatment.—Liberal diet is necessary, and the use of stimulants at meals is permitted, of course in strictly regulated quantity. Full doses of cod-liver oil should be taken after meals, along with the syrup iodide of iron, the latter up to a tea-spoonful, and even more if the stomach is undisturbed by it. Daily warm baths are most useful, specially warm baths accompanied by manipulation, as in the Aix. douche, or Vichy baths, which, of course, are best obtained in special resorts like Aix-les Bains, or Cauterets, in France, Spa in Bel gium, Harrogate, Woodhall, Droitwich, &c., in England. Ordinary Russian or Turkish baths are also useful, or warm pine baths, sulphur baths, mud baths, salt-water baths, but neither cold baths nor sea - bathing. if the patient can afford it, she should select a well-conducted spa, where, besides such baths, electrical treatment can be obtained, and the treatment by high temperature, such as the Dowsing or similar system of electric-light bath affords. Acute outbreaks may be relieved by salicylate of sodium, or saki, in large doses, 15 grains every 2 hours, though this, as a rule, can be maintained only for 4 or 5 days continuously.
Disease (Mbrbus Cane). The nature and progress of this disease are the same as those described under INFLAMMATION OF JOINTS. The hip-joint, however, is most often attacked, and particularly in children. It is a disease very often overlooked in its early stages, when it is most easily treated, and therefore should be specially noted. It is a tubercular disease, though it may be apparently begun by an injury.
Symptoms.--The child is affected with slight lameness, and drags one leg. This is most noticeable, in the very earliest stage, in the morning, passing off with exercise, and later, it is worst in the evening after. the fatigue of walking or standing all day. When the child is stripped, placed standing on a chair, and is looked at from behind, the pelvis of one side is seen to be drawn up and only the toes of that side touch the ground, or the foot is turned on edge and rested on the side of the other foot. When the child is laid on its back on a firm, flat surface the affected limb is bent at the knee, while the sound one lies straight out. When the bent knee is pressed flat on to the ground, the back at once becomes arched. If the child
be then turned on its face the buttocks of the affected side seem flattened and wasted. In the beginning the pain is often slight and occa sional, then it increases, and may be felt all over the thigh. In the later stages it is often felt chiefly at the knee, and this is apt to draw away attention from the hip. The pain may be brought out by pressing behind the trochanter —the projection of bone felt at the side of the hip—or in front over the joint in the groin. The most delicate test for the pain is to lay the person on the back, take the foot in the hand, the leg being bent at the knee and the thigh being bent up towards the body, the limb being at the same time turned away from the middle line, and in this position turn the foot gently ()awards. The muscles usually fix the limb so as to prevent movement at the affected joint.
Besides these special symptoms, those of start ing at night, &c., already mentioned under IN FLAMMATION OF JOINTS, are present.
Treat m e nt.—The treatment already described for diseased joints--splints, cod-liver oil and tonics, &c.—is applicable here. But it is neces sary also to keep the joint at rest, and remove the pressure from the head of the bone. This is done by continuous extension (Fig. 33). A broad strip of adhesive plaster (a) is applied to each side of the lower part of the leg by its ends in such a way that the long' loop of the plaster extends beyond the heel. The strip is secured by bands of plaster (c) round the leg. The loop is attached to a square piece of wood placed under it, and resting against the sole of the foot. From the centre of the wood stretches a cord (b) which passes over a pulley (d) attached to the foot of the bed. From the end of the cord hangs a weight (e) sufficient to keep up extension of the limb. The amount of weight is best judged of by the patient himself, but it should riot be less than 10 lbs. It may be slowly increased, and should be kept on night and day. While this treat . ment is going on strengthening food, &c., must not be forgotten, and if possible an arrange . ment should be ingde whereby the child may lie, most of the day, in the open air, specially inland and on high ground.
Housemaid's Knee See p. 122.