The pathology and treatment of morbus coxarius / by Lewis A. Sayre.

  • Sayre, Lewis A. (Lewis Albert), 1820-1900.
Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: The pathology and treatment of morbus coxarius / by Lewis A. Sayre. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    affection, we ma}' look to an injury or wound of the round ligament, as from some strain, or twist, or jump, when the muscles of the child are in a relaxed condition. The injury, however slight, causes subsequent inflammation, the extent of the disease depending much on the constitutional condition of the patient. This inflammation may lead on to secondary bone disease, or, in other cases, and in particular states of the constitution, we may have primary bone disease. Dr. 1). IIayes Agnew, of Philadelphia, said:—It is important in discussing this subject to understand what we mean by the term traumatic injury, as preliminary to the whole question. Now, if it is necessary that a joint should have a powerful twist, or wrench, or that a blow should be inflicted upon it, or that the patient should be projected from some height—that is one thing; but, if it is meant that a child by jumping down, for instance, two or three steps, or by tripping on the floor in walking over a carpet, can in such a way receive traumatic injury—that is another thing. My impression in regard to hip-joint disease is this: It is impossible to follow a child in all its move- ments. Most of the time the child is out of the notice of its mother, in the care of nurses, many of whom are exceedingly careless. The child may receive a great many slight injuries which may yet be quite sufficient to produce such a contusion or such an irritation of the joint as, in a child predisposed (for I must confess that there is after all a predisposition, which may remain latent if the child be kept absolutely at rest), may kindle up the slumbering elements and bring on the disease. I see a great many of these cases, and I must say that I usually find it not difficult to trace behind all a constitutional predisposition. In the family, perhaps, one child may have phthisis, and another enlarged glands, and another hip-joint disease, and another knee-joint disease. But, in most cases, the immediate cause of the disease is some external injury of the joint. Dr. Sayre said:—Both Dr. Gross and Dr. Campbell agree that some little injury may produce the disease. That is all that 1 claim ; 1 do not assert that it is necessary for a child to be run over by a railroad car. If coxalgia is con- stitutional, I would ask why it is that, having recovered from hip-joint disease, the patient becomes perfectly well, and sound, and hearty? wl^ is it that simply having hip-joint disease cures the constitutional taint? Dr. Gross said :—The difference between Dr. Sayre and myself seems to be simply this : He sa3rs that hip-disease is almost always of traumatic origin, and not necessarily connected with a vitiated constitution. I, and those who think with me, do not deny that injury ma}r excite the disease; on the con- trary, we confess that it frequently does so; but we maintain that the disease is always necessarily connected with a vitiated condition of the system. Dr. J. A. Grant, of Ottawa, said :—I must acknowledge that for many years I entertained similar opinions to those now expressed by Dr. Gross ; but in one or two cases observed during the last few years, in the hospital at Ottawa, where I see many cases of hip-disease, I have been forced to a different conclusion. One case came under my observation about three years ago, which I investigated most closely, and in which I failed to trace the slightest predisposition of a scrofulous character, either in the boy, or in either of his parents, or in any of his ancestors. In another case that came under my notice, the disease art>se purely from irritation or excitement in the joint, entirely independent of scrofulous complication. We must acknowledge, of course, that persons laboring under a scrofulous taint are much more liable to irritation, and to the development of this disease, than others; but we must also acknowledge, from the peculiar construction of the hip-joint, that it is one extremely susceptible to irritation, whether in a scrofulous constitution or in a constitution not of scrofulous character. I am of those who adhere to the view that we may have coxalgia occurring in an individual entirely inde- pendently of scrofulous taint.