The pathology and treatment of morbus coxarius / by Lewis A. Sayre.

  • Sayre, Lewis A. (Lewis Albert), 1820-1900.
Date:
1877
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Licence: Public Domain Mark

Credit: The pathology and treatment of morbus coxarius / 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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    in many cases constitutional, yet we know also of many cases of cancer which recover if operated upon early enough. There is a local manifestation of a hereditary taint, but if we take away the local manifestation, there may never be any other. This is the case also with struma. Glandular abscesses in the neck are strumous, and yet how many persons live to be healthy and sound after having these! It seems to me that if we have such a disease as struma at all, we have that disease in morbus coxarius. A child came to me in Glas- gow to be treated for disease of the tarsus. He was treated with a long splint, and after a while, though still lying in bed, with the splint, several weeks after- wards, morbus coxarius showed itself. In that child there was a constitutional tendency which developed itself without traumatic cause. But I admit that traumatic causes are frequently operative, and we know the constant liability of children to lie affected b}' traumatic causes. Dr. Gross said :—Have you ever seen suppuration in disease of the hip-joint, in which there was not scrofulus pus? Mr. Lister said :—I must confess that I have. In affections dependent upon strumous disease, there are great varieties of pus. The treatment which I have adopted has been, if there has been flexion of the limb, to extend it on a long splint, and keep the patient at rest. In the great majority of these cases in Edinburgh, perfect cures are obtained. In Glasgow, a considerable number of the cases are cured, but not so many as in Edinburgh. Then, again, in Man- chester the number of cures is a minority. Now I believe the reason for this is that Edinburgh is a more healthy place than Glasgow, and that Manchester is a less healthy place than Glasgow. Dr. Sayre said :—I can hardly find language to express my feelings of regret whenever I am compelled to differ in a professional point of view from my dis- tinguished friend Dr. Gross. But we must not let personal friendship, or per- sonal respect and veneration, guide us in the expression of our opinions upon points of science. It seems to be conceded that an injury is often the exciting cause of the disease. Now, with regard to the matter of predisposition, I say that the ordinary teaching has been erroneous, and I believe that the doctrine has led to bad results in treatment. If the disease is necessarily of constitu- tional origin, it cannot be cured by local means. You must get rid of the con- stitutional poison or taint. If it is of constitutional origin, the development of some constitutional cause, the treatment ought to be constitutional, to affect the blood and the whole body. What lias been the result of the belief in the constitutional origin of hip-disease? The use of internal remedies to correct the constitutional taint, and of local applications to the parts that are simply irritating. Dr. Gross has referred to the character of the pus: I happened to be present at an autopsy in a case of hip-disease in Berlin, made by Prof. Vir- chow, where an examination was made of the lungs, and heart, and intestines. In the specimens taken from that case there was not a trace of tubercular matter to be found. It was simply a case of pure chronic coxalgia. The pus was not of the kind referred to by Dr. Gross. Had that case been carefully exam- ined and properly treated, in my judgment it would not have terminated fatally. The trouble was a local one, and the constitutional effects of the local trouble were mistaken for its constitutional origin. Prof. Gross will remember seeing a little child whose hip I exseeted in Brooklyn. If there ever was a strumous condition, that child’s condition was certainly entitled to be called so. In fact the child was almost dead at the time of the operation. It had lain in an exhausted condition for live or six years, with continued suppuration, j^et by removing the cause of the trouble, without any constitu- tional treatment, or medicine of any sort or kind except something to eat and fresh air, from being a dead child, the child is running about to-day in perfect health. I sent its picture as a Christmas present to Dr. Gross himself. Now, in reply to the remarks of Dr. Richardson about cases of congenital disloca- tion, I may say that congenital dislocation has never been seen, although if has been described bjr Dr. Carnochan and others, and I believe that I am justified