Volume 1

A system of surgery / by Charles B. Ball [and others] ; edited by Frederick Treves.

Date:
1896-1898
Catalogue details

Licence: Public Domain Mark

Credit: A system of surgery / by Charles B. Ball [and others] ; edited by Frederick Treves. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    1117/1206 (page 1075)
    from the latter class of patients, inasmuch as they are real sufferers from a distinct pain which is anything but imaginary. The condition is distinguished from structural change by the absence of all objective signs of disease in the joint, such as swelling, heat, altered colour, or deformity, and by the character of the suffer- ing. Such patients, too, will use the joint affected as well as the other, and even may experience a sense of relief in so doing. After rest of the whole body, however, the pain is usually relieved, as also after the enjoyment of food and sleep. Treatment.—The treatment of this neuralgia will be general and local. In the first place every means must be adopted to strengthen the whole body. All exhausting work must be given up, and the patient must take abundance of sleej) and regular exercise in fresh air, with plenty_ of suitable digestible food. Stimulants are to be avoided, but tonic medicines, especially nux vomica and iron, will do much to assist the digestion and restore general tone. Locally, blisters or rubefacients are useful. But in many cases nothing is so efficacious as the application of the actual cautery in the form of the hot button over the seat of pain. The part should also be protected against exposure to extremes, either of heat or of cold, by coverings of flannel or wool. Friction with liniments con- taining chloroform and befladonna is often efficacious. In many oases, too, a regular course of massage may be recommended where other means fail. AFFECTIONS OF THE HIP JOINT. This joint claims our first attention, not only on account of its size and importance for progression, but also on account of the frequency with which it is the seat of disease. Simple acute synovitis of the hip,—This simplest form of acute disease is not as common, however, here as in other joints owing to the fact that the articulation is protected, in a measure apinst external influences by its great depth among the muscles.’ Nevertheless, it is occasionally seen in its purest form as the result of overstrain or exposure. Syini>toms.--The subjective symptoms are heat and stiffness, followed by throbbing pain, referi’ed to the joint itself, and also to the knee. _ This latter symptom is explained by the connection between the two.] oints through the obturator nerve. Tenderness and pain are most marked over the front and back of the joint, and cause limpinv very early, and, later,_ complete uiability to use the limb. ^ Objectively, swelling is also noticed in two situations—i.e. over the ivont and back of the capsule—and is due partly to effusion into the synovial sac, and partly to oedema. EednL is rarely seen on account of the depth of the part beneath the surface. ^Next o this, the most striking symptom is the position of the thi<rh If the patient be young, and the inflammation recent, stron<r flexion, abduction, and eversion will be present. The causes of