DISEASE OF TI1E HIP-JOINT. Hip-disease dif fers in so many points of importance from other joint-diseases, and i5 so serious an affection that it requires a special notice. Its connection with the scrofulous or strumous diathesis is more dis tinctly marked than that of most other joint diseases, and it almost always occurs before the age of puberty. It is essentially a tubercular inflammation of the hip-joint. its beginning may be often associated with some trivial occurrence, such as over-exertion in a long walk, a sprain in jumping, or a fall.
in the early stage of the disease, the whole of the structures of the joint are inflamed, and by proper treatment at this period the morbid ac tion may be sometimes subdued without any worse consequences than a more or less rigid joint. Usually, however, abscesses form around the joint, and often communicate with its inte rior; and the acetabnlum, and the head and neck of the thigh-bone, become disintegrated, softened, and roughened. in a still more advanced stage, dislocation of the head of the thigh-bone com monly occurs, either from the capsular ligaments becoming more or less destroyed. and the head of the bone being drawn out of its cavity by the action of the surrounding muscles, or from a fungous mass sprouting up from the bottom of the cavity, and pushing the head of the bone be fore it. It is of extreme importance that the
symptoms should be detected in an early stage of the disease, and surgical aid at once be sought.
As the disease advances. abscesses, as already mentioned, occur around the joint, which some times, from the tension they exert on the obtura tor nerve, occasion extreme pain in the inside of the thigh. True shortening of the limb now takes place. which at the same time becomes adducted and inverted. From this stage, if the general health is good. the patient may be so fortunate as to recover with an anchylosed (or immovable) hip-joint: but occasionally a condition of exhaus tion conies on. the tubercular process exhibits itself in the lungs and elsewhere, and death finally supervenes from the prolonged septic processes. The duration of the disease may vary from two or three months to ten or more years. The essential factor in the treatment of these cases is complete immobilization of the joint for a protracted period by means of plaster splints or rigid metal braces. With this must he combined nourishing food, fresh air, and sunlight, with general exercise of the body as early as is prac ticable.