The hysterical element in orthopædic surgery / by Newton M. Shaffer.

  • Newton Melman Shaffer
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: The hysterical element in orthopædic surgery / by Newton M. Shaffer. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    Indeed, a diagnosis of morbus coxarius had already been made by a prominent surgeon of Albany, who had examined the case a few days prior to my visit ; a diagnosis, however, which Dr. Seymour had rejected. After dinner a critical examination of the patient was made. In the standing position there was at once apparent a slight discoloration of the tissues over the knee joint, a marked flexion of the articulation (about 35°), and a perceptible atrophy of the thigh and leg. The patient stood in the attitude characteristic of hip disease, with exagerated flexion at the knee. Almost the entire weight of the body fell upon the unaft'ected limb, and there were evident the lowered gluteo femoral crease, the flattened natis and the tilting downward of the pelvis on the affected side, which makes the limb seem apparently longer, and produces the symptomatic lateral curvature of chronic coxitis. When asked to bend forward to pick up a key from tlie floor, the patient carried the entire limb, in its deformed position, back- ward with the pelvis, refusing to bend in the slightest degree either the hip or knee. When the patient walked, little or no motion was apparent at the hip joint, the knee was neither flexed nor extended, and the limp was very marked and characteristic of chronic osteitis of the hip or knee. The patient was now i)laced in the supine position. It was found that the affected knee joint was slightly warmer than its fellow, and tliat there was an almost complete obliteration of the fossje on either side of the patella. There was tenderness on pressure over the condyles of the femur, and below, over the ligamentum patellae. This tenderness was not present on the opposite side. The limb was then exam- ined as to the passive mobility of the hip and knee joints. When the limb was moved as a whole, with the knee in its acquired position, no muscular rigidity existed at the hip. But if the attempt was made to flex the thigh on the pelvis, at the expense of motion at the knee, a very decided resistance was experienced at the hip. When the attempt was made to flex or extend the knee, it was found to be rigidly held in its deformed position by a very decided muscular contraction, and when a slight degree of force was used, the joint refused to yield, and the ])atient gave evidence of pain, both by facial expression and orally. The pain was referred to the inner side of the joint. A persistent attem])t to flex the leg on the thigh, using a continuous rather than a great degree of force, was followed by a very ])erce])tible, almost audible click, which, Dr. Seymour remarked, reminded him of the sensation imparted to the hand as a knife blade