OCR Text |
Show 100 straw mu... ". . i DISEASE or run mr JOINT. other direction. This is owing to the relation of the bones, or entire dislocation of the femur. There is a peculiarity in the seat of the pain, too, which must be held in remembrance, else we shall be employed in fomenting the knee and leg for a disease in the hip. I have found a disease of the nerve in the ham, producing pain in the sole of the foot, continued for nearly two years. So I believe that in this case the ischiadic nerve passing so near the seat of disease, is affected, and pain is the consequence, which is attributed to the outside of the thigh, the knee, and leg. When the pain is deep in the groin and in the inside of the thigh and knee, it is probable that the obturator nerve may be involved in the inflarmnaw tion. When suppuration takes place, there are startings and catchings during sleep. The pain is increased, with much tension and throbbing ; now the skin inflames, and the abscess bursts either in the groin or behind the troehanter. Successive abscesses will sometimes form around the joint, and still the patient survives. The limb being fixed,‘the granulations of the inflamed joint run together, they ossify, and an anchylosis is formed. But often, the abscess advancing, and the skin being inflamed, hectic fever rapidly reduces the patient, there is per f. l g. l 1' . a [mar-"tn; -‘r'1;,;‘.~f.~m-<I_.. pug-.1 . _ .s spiration, diarrhoea, a white tongue, a face changing from the hectic flush to the leaden coloured paleness of those who are tabid ; they linger thus, and die. This hip disease is an inflammation peculiar to the scrophulous constitution. It attacks the ligaments and cartilage in the parts enjoying a less active and vigorous circulation. There is danger of its being confounded with rheumatism, gout, or the psoas abscess. As to the cause, it is scrophulous disease. The bones and joints of the lower extremity are most liable to disease, and of these chiefly the larger joints : therefore the knee is most liable to disease ; next in frequency is the hip joint; then 111" ancle joint. DISEASE or THE me JOINT. 101 Dissections prove that the cartilage is absorbed, that the bones of the pelvis forming the socket, and the head and neck of the thigh bone are wasted and carious ; or after the inflammation of the bone, and the wasting of the cartilage, the bones unite and form an anchylosisfi Anchylosis is not necessarily the cure of the disease, nor a natural termination to it. I believe it takes, place thus :The inflamed bone not being under the influence of that law which contracts and directs the growth of parts in their na- tural action, irregular processes are formed, which, projecting, hinder the motion of the joint; by the loss of motion the incessant irritation of inflamed parts, moving on one anether, is taken off the joint, the latter being new preserved steady; the bones unite; and the surrounding abscesses be- ing no longer festered by the pain and irritation within, they are contracted and dry. In the cure, I have advised repeated small mercurial purges, with hot fomentation, when the complaint seemed doubtful. If the complaint begin with a violence of the inflammatory symptoms proportioned to the injury to be produced afterwards, both to the joint and the system, bleeding would first of all be thought of. But, when the surgeon is first called, there is a low irritability, with a quick, small pulse, and he is more inclined to apply stimulants to the surface, without further reducing the action of the part by leeches ; or supposing that the disease appears in a state so equivocal that the patient thinks it still rheumatic or gouty, a large stimulating plaster may be applied to the hip and thigh. But if the complaint be distinctly marked, the caustic is to b'? immediately applied. ‘ Fee n'ha‘ is said on the subject cf tumours. |