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.

    7/39
    THE PATHOLOGY AND TREATMENT OP MORBUS COXARIUS. The time allotted me for discussing Morbus Coxarius, its causes, symp- toms, and treatment, is so limited, that I can only briefly refer to the first two, and for more minute information must refer you to my pub- lished writings on this subject, where more definite and full information has been given ; and I shall occupy a portion of the time with a practical illustration of the plan of treatment in each different stage of the disease, as being the best manner of conveying the largest amount of information in tlic time that has been allotted to me. Morbus coxarius, or hip-disease, as it is generally called, is more fre- quently observed in childhood and early youth than at any other period of life, although it may occur in the infant or the adult. It is generally, if not always, the result of some direct injury to the joint involved, either (1) by a blow or concussion of the head of the femur against some portion of the acetabulum, producing an extravasation of blood in the network of vessels underneath the articular cartilage of one of these parts, and ending in caries and necrosis; (2) by some strain or overstretching of the joint, producing rupture more or less complete of the liganientum teres, and its vessels and nerves, thus interfering with the nutrition of the head of the femur, and inducing necrosis; or (3) by excessive violence and over-exer- tion, producing free perspiration and synovial secretion, which is sud- denly checked by an exposure to damp and cold, thus producing a syno- vitis which not unfrequently ends in suppuration. The young infant is protected by the watchful mother or the careful nurse; and the adult has generally sufficient prudence to protect him- self; but the reckless, romping, healthy child indulges in wild sports without discretion, and slight injuries are unnoticed until serious con- sequences have resulted, and often until so long a time has elapsed between the receipt of the injury and the development of symptoms suf- ficient to attract attention,that the cause of the difficulty is entirely for- gotten, and the constitutional effects of long-continued irritation and suppuration are mistaken for the cause of the disease, instead of the result. Until within a very few years, every author taught that the disease was necessarily connected with a strumous condition of the system, and could not exist without it, and that it was therefore necessarily of con- stitutional origin, and never occurred in the robust and healthy. This doctrine I believe to be incorrect; in fact, by a careful examination of my recorded notes of many hundreds of cases of morbus coxarius, I find that by far the larger number occur in children of perfect health, and born of healthy ancestry, and the simple reason is that children of this class are more active and daring, and therefore more exposed to accidents and in-