Annual and analytical cyclopaedia of practical medicine . agnosis be-tween hip disease and lumbar caries thissymptom is of value, as in the latter dis-ease the reflexes are much less apt to beexaggerated and the reflexes on bothsides are equal. Braokett (Boston Surg. Mar. 31. 92). Both legs lying flat upon the tableshould then he moved to and fro, toascertain, if possible, the presence orabsence of muscular spasm. It is frequently advised that an anses-thetic be administered, in order that thecondition of a diseased Joint may he thor- such long standing that there should beno di
Annual and analytical cyclopaedia of practical medicine . agnosis be-tween hip disease and lumbar caries thissymptom is of value, as in the latter dis-ease the reflexes are much less apt to beexaggerated and the reflexes on bothsides are equal. Braokett (Boston Surg. Mar. 31. 92). Both legs lying flat upon the tableshould then he moved to and fro, toascertain, if possible, the presence orabsence of muscular spasm. It is frequently advised that an anses-thetic be administered, in order that thecondition of a diseased Joint may he thor- such long standing that there should beno difhculty in reaching a diagnosis evenby an inexperienced observer. The mode in which to determine mus-cular spasm in the early stages of thedisease, at which time it is most impor-tant to arrive at a correct diagnosis, is,first, to thoroughly gain control of thepatient, and cause it to allow completemuscular relaxation, as a child will, inmany instances, voluntarily stiffen itsmuscles when first examined, and thusmask the presence of a slight involuntary. Kight hip-joint disease, showing tilting of pelvis. oughly investigated. As far as diagnosisis concerned, this is absolutely unneces-sary. The administration of the anaes-thetic, by the removal of the sensitive-ness from the joint, removes the neces-sity which Nature feels for establishingthe involuntary muscular protectionwhich she gives all inflamed joints, andthus removes from the surgeon a mostvaluable means of diagnosis. If therigidity of the joint is due to adhesions,and so persists after the anaesthetic hasbeen administered, the case has been of spasm. The Joints should then bemoved through all normal ranges ofmotion, beginning with the sound side,and slight involuntary twitches takeninto account. It is usually quite unnec-essary to manipulate the joint so vio-lently as to cause pain, in order to arriveat a correct diagnosis, and, in the major-ity of eases, pain will not be elicitedunless very extensive movements aremade
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