On the successful treatment of cases of congenital displacement of the hip-joint by complete recumbency with extension for two years / by William Adams.

  • William Adams
Date:
[1890]
Catalogue details

Licence: Public Domain Mark

Credit: On the successful treatment of cases of congenital displacement of the hip-joint by complete recumbency with extension for two years / by William Adams. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    16/18 page 14
    the improved plane, as in the previous case, so that the child could be drawn out daily in a spinal carriage. On October 29th, 1886, this treatment was commenced, and no> difficulty was experienced. December 28th, 1886. I examined Miss W., and there seemed to be some improvement. With the slight extension on the plane, the shortening of the right leg was completely removed; but when the extension was released, the top of the great tro- chanter ascended again, but not so far as before treatment was commenced, hardly more than a quarter of an inch according to my note. The disposition to evert the foot was at first controlled by sandbags, and afterwards by a splint contrived by Mr. Ernst* This little child was constantly under the observation of Dr. Thomas May, and seen by myself at intervals of about two or three months. The mother was extremely attentive to all the details of treatment. About the end of the first six months, on Tuesday, April 19th, 1887, Dr. May and myself carefully examined the child, with and without the extension, and the result appeared to be very satis- factory. When the extension was removed, the legs remained very nearly the same length, and the head of the femur was evi- dently becoming more fixed in the improved position; the great trochanter did not ascend spontaneously. On Thursday, December 22nd, 1887, 1 made another careful ex- amination with the same result and measurements as before. The general health remains very good. It is now a little over one year since the treatment was commenced. On Thursday, May 10th, 1888, Dr. Thomas May and myself ex- amined our little patient again carefully, only with the result of the same favourable reports as to the length of the legs, which were very nearly equal, and the head of the femur becoming more firmly fixed in the improved position. There had been noticed some little tendency to elevation of the heel, or rather, I should say inability to flex the foot beyond the right angle, no doubt caused by the foot being so long retained in a position with the toes pointing downwards during the extension, and for this I directed passive movement of the foot with the right hand, whilst some extension of the leg was being made with the left hand. There was nothing further to report. On Wednesday, October 31st, 1888, as Miss W. has now com- pleted her two years of recumbency with extension which she began on October 29th, 1886, it was arranged that she should begin to walk with a mechanical support, and for this purpose Mr. Ernst took careful measurements of the right leg, which he compared with the left. The legs were very nearly of equal length; not more than one eighth of an inch shortening on the right side could be measured. No inclination to spontaneous dis- placement, or any movement upwards, when a little manipula- tion to test this was applied. The ilio-femoral triangle was nearly equal on both sides, the right being about an eighth of an inch less. The joint movements are all free, and the muscular power very good. The general health is excellent, in no way injured by her complete recumbency, with extension, night and day for two years. During this time she has had a mild attack of measles, and also the whooping-cough, but the extension was not materially interfered with. Monday, November 12th, 1888. Miss W. began to walk to-day with the instrument which Mr. Ernst has constructed for these cases, and I have described in the paper. Mr. Ernst applied it, and, with my assistance, the little girl walked about the room for
    digitised image 1
    digitised image 2
    digitised image 3