For some time the general health remains uninterrupted; but, when the disease advances so as to be acutely sensible to the touch, with an acute or throbbing pain, and a redness of the skin, hectic exacerbations come on; the patient starts in his sleep; the face is of a leaden paleness, except when flushed with hectic heat; the skin is clammy; the body wastes, and the strength gradually sinks.

The shortening of the limbs has been esteemed a mark of suppuration coming on; but this is not correct. The limb is sometimes shorter from the beginning, as well as in the advanced stages; nor is any certain consequence to be drawn from this circumstance, unless it suddenly becomes so, when it may give some suspicion of matter having formed.

On dissection, the head, sometimes the neck of the thigh bone, is carious; nor is the change confined to this bone, for the acetabulum equally suffers, and the matter has been found to escape through it into the cavity of the pelvis. Matter in proportional quantities is occasionally found in the cotyloid cavity.

In. this disease there is evidently relaxation of the ligament, with a slight inflammation. It probably begins with inflammation of the head of the bone, like that which occurs in the vertebrae, in cases of distorted spine, and gradually presses it downward, upward, or to either side, according to the portion of the head affected; and this will account for all the variety of lengthening or shortening of the limb; for the difficulty of moving the legs sideways and outwards, or, for what sometimes happens, of keeping them together.

It is often confounded with rheumatism, and with psoas abscess; but from each may be distinguished by the elongation or the abbreviation of the limb, by the increased breadth of the nates, and the laxity of the glutaei muscles. In the earlier periods also of psoas cases, the difficulty of bending the body, or of putting either leg forward, will sufficiently point out the part affected, while the pain on pressure, dragging the toe, and the relaxation of the glutaei muscles, will sufficiently distinguish it at a subsequent period. In rheumatism also the pain is more extended, the earlier fever more considerable, with often external soreness. At every period of the complaint the prognostic must be unfavourable; but if the constitution is sound, without any scrofulous taint, the disease incipient, and the patient willing to pursue the necessary plans, we sometimes succeed. Even when suppuration has come on the patient may escape, but it must be by the efforts of nature alone. In such cases the abscess occasionally bursts, though this sometimes docs not occur, and the matter is absorbed. In each circumstance the most absolute rest, free country air, a milk diet, keeping the bowels free, with the occasional use of the bark, are chiefly useful. If any thing is more essentially necessary than the others, it is absolute rest, with free country air. If any thing is less so, it is medicine. A stiff-jiess of the joint is, however, the inevitable consequence.

The causes appear to be most generally cold, from damp beds, and lying in damp sheets. Blows and strains also induce it; but in children it often comes on without the known influence of either, and seems to be of a scrofulous nature, as it chiefly affects those whose appearance shows the seminium of that disease.

The cure of the disease, in the earlier or middle stages, requires peculiar attention in the practitioner, and no little resolution in the patient. Inflammation, we have said, is the first symptom, and bleeding with leeches, a moderately low diet, occasional doses of neutral salts, together with the continued discharge of a blister, will succeed. If the season permit, sea bathing or cold pumping will complete the cure. In this state, also, a light infusion of the bark, or any other bitter, seems to have been of service. Should, after a trial of this plan, the disease continue, or seem to increase, an issue should be made just behind the great trochanter. The application of a caustic will, on the separation of the eschar, form a deep sore, which should be so large as to require, both in breadth and depth, a horse bean for its continuance. Tenderness is in this case cruelty: it should be done effectually, or wholly omitted. If the pain and fever have not been violent, or have been mitigated by the usual remedies, sea bathing may be continued with this issue, as it can be easily covered by leather spread round its margin with sticking plaster. Some surgeons have recommended a seton; but the cord does not penetrate so deep, and cannot be so conveniently covered to admit of sea bathing, which is a most essential remedy.

Instead of leeches, cupping glasses have been recommended; and instead of blisters, the lime poultice, made of one part of quicklime slacked in the air, with two parts of oatmeal, made into a poultice with hogs' lard. These are less effectual remedies, though sometimes useful in irritable habits, where the terror excited by the more acute remedies might be injurious. They should be trusted, however, only in the slightest cases. Opiates, particularly in the form of Dover's powder, may, at any period of the disease, be allowed with safety; and often when the pain is violent with advantage.

Though we have chiefly trusted sea bathing and cold pumping, yet the annals of the Bath hospital speak with confidence of the utility of warm pumping; and Dr. Falconer has lately given a very satisfactory view of its utility. The Bath waters can only be admitted when fever has not come on, or when it has been checked by the appropriate remedies. If the patient be tolerably strong, and the symptoms moderate, the bath of 105° is used two or three times a week, and the patient continues in it from fifteen to twenty-five minutes. After bathing a few times, on the intermediate days, the part is pumped on for about five minutes, when the patient receives 500 strokes. From this remedy the stiffness and pain arc relieved, the soreness and swelling diminish, the strength and plumpness of the limb gradually return, and the leg, whatever was the change, resumes its natural length and direction.,