Results in cases of hip-joint disease treated by the portable traction splint without immobilization, except during the inflammatory stage of the disease / by Lewis A. Sayre.

  • Lewis Sayre
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Results in cases of hip-joint disease treated by the portable traction splint without immobilization, except during the inflammatory stage of the disease / by Lewis A. Sayre. 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.

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    sultatioii witli Mr. WilUam Adams and Sir James Paget, wlio Iiad been attending the lad, in connection with Dr. Quain for disease of the right hip joint since April, 1877. The mother was an uncommonly healthy and vigorous woman of about thirty. The father, an unusually stout and robust man, had died of apoplexy. The boy had fallen out of a brougham while driving on a hard road in Ireland in November, 1876, during his mother’s absence, and the nurse had concealed this fact for some months. He gradually grew stiff in his gait, and then became quite lame. The lameness increased and the joint became very painful, espe- cially at night, waking him out of a sound sleep with frequent paroxysms. The mother brought him to London to consult Dr. Quain', who called Sir James Paget and Mr. William Adams in consultation, and they all agreed in the diagnosis of hij) disease of the right side^ and confided him to Mr. Adams for treatment. Sir James Paget and Dr. Quain seeing him occasionally. Mr. Adams applied a stiff molded leather to the hip and a splint to the leg, with extension by weight and pulley, and forbade the child to walk—an imitation, or, as he said, “ a modification of the American plan of treatment.” The case not progressing favorably, Sir James Paget became dissatisfied with the American plan, and I was called in consul- tation in August, 1877. There was no difference of ojunion as to the diagnosis. We all agreed that it was an unmistakable case of hip disease in the first stage, rapidly advancing to the second stage. There were flexion of the thigh, abduction of the limb, eversion of the toes, and perfect immobilization of the joint from muscular rigidity, and the very slightest pressure on the trochanter, or upward from the knee or heel, caused the most exquisite pain. The slightest attempt at movement with- out traction was unbearable. But as soon as slight traction was made in the direction of the distorted limb, while the pelvis was held immovable, very slight motion could be made at the joint without pain. We did not agree in the opinion as to the cause of the trouble. They were disposed to attribute it to the strumous condition of the boy, on account of the great disparity in the ages of his parents. But, as they were both in perfect health at the time of his birth, and the boy had always been in perfect health uj) to the time he was thrown from the brougham, 1 was disposed to attribute the disease to this accident, and not to any constitu- tional diathesis. We also differed in our ])rognosis of the case. They con- sidered recovery with ankylosis a very good result; and I con- tended that many patients recovered with good motion, and