. The diseases of children : medical and surgical. vity is in-volved, a large surface— the whole ace-tabulum—is at once exposed to irritation,and so the process in it is more rapid ; italso depends upon how much the head ofthe femur has been allowed to press uponthe pelvis. It is very rare to find any attempt at anew formation of bone while the disease is progressing, while, after removalof the upper end of the femur, new bone may be rapidly formed ; in this, ofcourse, the hip resembles other joints. The rapid formation of new boneafter excision is a strong indication for that operation, i
. The diseases of children : medical and surgical. vity is in-volved, a large surface— the whole ace-tabulum—is at once exposed to irritation,and so the process in it is more rapid ; italso depends upon how much the head ofthe femur has been allowed to press uponthe pelvis. It is very rare to find any attempt at anew formation of bone while the disease is progressing, while, after removalof the upper end of the femur, new bone may be rapidly formed ; in this, ofcourse, the hip resembles other joints. The rapid formation of new boneafter excision is a strong indication for that operation, in that it shows thatnature is unable to begin repair until the disease is removed. The etiology and pathology of morbus coxse, then, may be summed up asfollows : I. Hip disease is dependent upon that deficient power of recovery andtendency to caseous degeneration which may be called the strumous or scrofu-lous, or, better, the tuberculous diathesis, and this constitutes the predisposingcause. The disease is, in fact, a local tuberculosis. Y Y. Fig. 157.—Shows extensive Acetabulardisease. The ihum is completely de-tached from the other two bones, andis largely necrosed ; white scale-likepatches of new bone are seen on thesurface. The disease was acute. 690 Hip Disease 2. Any slight or severe injury, over-use, &c., or the onset of a specificfever, may, in such a constitution, prove an exciting cause. 3. Injury in a healthy child may produce synovitis, or even acute inflam-mation of bone about the hip, as elsewhere, but this does not, except veryrarely, lead to chronic hip disease. 4. In the vast majority of the cases of morbus cox^ the disease beginsas an osteomyelitis of the upper epiphysis of the femur, or of the immediateneighbourhood of the epiphysial line, or not very rarely of the acetabularepiphysis. 5. This particular osteomyelitis tends to destruction, and usually runs achronic course with caseation of the inflammatory material, and resolutioncan rarely, if ever, b
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