COULSON ON THE HIP-JOINT.
ALTHOUGH, happily, not a common, the disease of The hip-joint is not an unusual complaint; and is remarkable, not only from its character, and the proof it affords of the efforts which Nature is ca- pable of, but for the slow way in which it. develops itself to a non- professional apprehension, owing to a beautiful provision, by which a joint in such continual and powerful action is endued with no more sensitiveness than is necessary to vitality. The first symp- toms of the decay and destruction of the joint, are a stiffness of the limb affected, mostly felt in the morning; to this succeeds a difficulty in stooping, and a sense of fatigue and weakness after the slightest exertion. Occasional darting pains are felt down the thigh, as well as a pain in the knee, owing to symptomatic inflammation, brought on from the inflammation of the insensible parts. And these symptoms are soon succeeded by limping, or a slight degree of lameness. The time that this stage of the disease may continue, varies with varying circumstances. Mr. COULSON fixes its usual duration at "ft-ow one month to six months."
In the second stage, all the above-mentioned symptoms are ag- gravated. The hip becomes flatter; the total inactivity of the muscles causing them to waste. The affected limb is somewhat longer than the sound one, and becomes thin and flabby. The pain in the knee is very severe, and impedes every motion of the limb. As the disease advances, the general health is affected ; the pulse is accelerated, the face alternately pale and flushed, the skin moist and clammy, and the tongue white. Distressing start- ings and catehings, during sleep, are frequently observed; the flesh wastes, and the strength declines. , In the third stage, the first apparent symptom is the shorten- mug of the affected limb. But the extensive mischief soon de- velops itself that has been going on internally—the inflamma- tion and subsequent destruction of the ligaments, cartilages, and synovial membrane (whose use is to secrete the " together with the caries of the head and neck of the thigh-bone.
Ulceration takes place; an abscess is formed ; and the peccant matter discharges itself in various directions, but most favourably on the outside of the thigh. Small portions of the bone some- times come away ; and there have been instances of the head of the femur itself being thrown off almost entire. In some cases the discharge is accompanied with hmmorrhage, to such a degree as to cause death. In others, if the strength of the patient can be supported, anti skilful and patient surgical assistance be afforded, Nature, after the total destruction, it may be said, of the joint, and months of tremendous agony, forms an anchylosis (stiff joint) with the remaining parts; and, in favourable cases, the only ill effect which remains, is a certain degree of shortening, and an impeded motion of the limb. Nay, such is her via medicatrix that she has attempted the formation of a new joint, and so far suc- ceeded as to permit it some degree of motion. But the third, and perhaps the more usual termination, is death by an analogous dis- ea-e of sotne vital part, as consumption of Vie lungs. Such is an unprofessional but intelligible description of this t'er- rible dist as. Its more immediate cause is cold, a local injury, or over-exertion, as in walking. But the disorder frequently appearS, as in inthete, without any proximate reason ; and there has latterly been a tendency to attribute its exciting cause to a scrofulous onstitution. This opinion Mr. COULSON strenuously advocates, giving it shape and consistency : of course he does not deny that any severe injury may induce the disease ; but, as a general rule, he holds that a slight local cause merely facilitates the develop- ment of a constitutional disposition. Nor is this merely a theoreti- c-al opinien. If the disease of the hip-joint be held to arise from local causes, it can only require local treatment. In the more en- larged view, the local treatment, though necessary, is merely sub- ordina'e. The final cure, and a permanent security, not only from this, but from other disorders of a more fatal though less excru- ciating kind, must be obtained by remedies adapted to improve the general health.
The able work which has afforded us the opportunity of giving this coup dwil of its subject, is too strictly professional to admit of any full description. Let it suffice to say, that Mr. Com.soer has thoroughly exhausted the subject; and has brought to his task the results of considerable study of other writers, and, what is still better, of a wide observation of disease in the living and of patho- logical examination in the dead, carried on under peculiarly favourable circumstances.
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