This is one of the most important affections of the joints, and its symptoms should be understood by all, as the disease frequently begins quite insidiously There is a difference of opinion among surgeons as to the cause of this affection, some attributing it chiefly to scrofula, while others, particularly the eminent Prof. L. A. Sayre of New York, insist that it is chiefly due to injury of some kind. The usual symptoms are, drawing up of the leg, wasting of the muscles, and pain in the region of the knee. The patient frequently cries out in the night from pain of the limb. As the disease progresses, the thigh becomes rolled outward, the child limps as he walks, and stands with one heel raised from the ground and the toe turned out. If examined when stripped, it will be noticed that the fold beneath the buttock is higher upon the affected side than upon the opposite. As the disease advances, the limb becomes still more drawn up and the hip-joint stiff. Although for several months, at first, the patient may be able to run about freely, he now becomes able to use the limb much less, or not at all. If he be laid upon a table, or other hard, flat surface, being stripped for the purpose, it will be noticed that the body curves upward and the affected limb is slightly bent, as may be seen in Fig. 394.

Fig. 394.

Fig. 394.

If now the affected limb be raised, as shown in Fig. 395, the curve in the back disappears. If the same thing is done with the sound limb, no change will be made in the curve of the body. If both limbs are bent and moved from side to side, or otherwise, together, it will be seen that the pelvis, although a part of the trunk, moves with the limbs. Even when the pelvis is held firmly by an assistant, it will be found to move whenever the affected limb is moved, showing that the joint has become stiff, or that anchylosis has taken place. The buttock of the affected side will be found to be somewhat flattened on account of the filling up of the hollow observable m the sound hip. If a slight blow is made upon the sole of the foot when the limb is extended, pain will be felt.

Fig. 395.

Fig. 395.