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Related post: bone, and to have entirely destroyed the whole inner surface
of the compact tissue of the shaft just anterior to the tro-
chanter minor. The compact tissue below the trochanter ma-
jor was very thin, and had a worm-eaten Buy Phenytoin Online appearance.
Remarhs. — It is probable that the disease in this case be-
gan in the head of the bone as an articular osteitis, and that it
extended down the shalt. The existence Buy Cheap Phenytoin of hereditary syphilis
is rendered probable by the rupia and pemphigus on the feet
and hands. There was an abscess above Poupart's ligament,
but no pcrfurTltion of the acetabulum. There was disease of
the rim of the pelvis.
In looking over the histories of these seven cases, it will be
noticed that they were all in an advanced stage of the disease ;
that from the condition of the Generic Phenytoin bone a cure by means of rest
EXSECTIOJf OF THE HIP-JODfT. 463
an3 mechanical support was impossible ; and that, unless re-
lief from the pain and irritation was afforded, a speedily fatal
termination was inevitable. Exsection of tlie joint afibrded a
chance, and, even if not successful in giving a sound limb,
afforded immediate relief from all pain, and made what re-
mained of life comfortable.
In four cases the shaft of the femur was diseased below the
point of section, namely, in Cases II., IV., V., and YI. In
Case TV. the whole diaphysis was removed, while in two
cases, Nos. II. and Y,, after some months the wound was
opened and a further section made of the bone. iNTotwith-
standing the unhealthy condition of the shaft in Cases II., lY.,
Y., YI., the wounds healed, but with a sinus leading down
to the end of the diseased bone ; and the patients were able to
go about the ward, and out, with the assistance of a crutch,
without any pain. Case I. was discharged with the wound
and all the sinuses healed ; no dead or exposed bone could
be found ; and able to go about without a crutch. Cases III.
and lY. died : one from secondary disease in the superior max-
illa, and the other from phthisis. All the patients (except
III. and lY.) are able to bear considerable weight on the dis-
eased limb, and complain of no pain upon pressure. In Case
Y. the limb is stiff at the hip-joint, and since the bandage has
been removed has increased in size, and is as large as the
other.
The diagnostic value of an abscess or sinus above Poupart's
ligament, indicating perforation of the acetabulum, as pointed
out by Barwell in his work on " Disease of Joints," and by
Bryant in the Medical Times and Gazette, 1869, is well illus-
trated in Cases I., lY., and Y. In the first there was a sinus
above the crest of the ileum and perforation, and in Cases lY.
and Y. there was a large abscess pointing above Poupart's
ligament and perforation of the acetabulum ; while in Case
YII. there was a large abscess, no perforation, but disease
of the rim of the pelvis. Purchase Phenytoin In Cases II., Y., and YI., there
is enlargement of Buy Phenytoin the liver, and in Case YI. there was a trace
of albumen before the operation, but there has been none
since. In Case YII. there is reason for thinking that there is
an hereditary syphilis. The advancing disease of the bones
464 EXSECTION OF THE HIP-JOINT.
of the pelvis, as well as the shaft, precludes all hope of re-
covery.
The acetabulum was extensively diseased in Cases I., II.,
TV., Y., and YII., while it was only roughened in Case YI. The
shaft of the femur in Cases XL, lY., Y., and YI., was Order Phenytoin diseased
at the time of the operation below the point of section ; and in
Case YII. the section had to be made below the trochanter
minor on account of extensive caries above that point.
The appearance and condition of the bone in the four cases
were alike ; it was soft and discolored ; the periosteum seemed
simply to envelop the bone without being intimately attached
to it, so that the shaft could be easily drawn out of it ; the
cut end of the bone in thi*ee of the cases resembled rather
coarse cancellous tissue, having its meshes filled with a dark-
red granular material. The external compact tissue was re-
duced to a mere shell ; while in the fourth the centre of the
bone had disappeared, leaving a cavity which readily admitted
the finger for two inches or more. In the latter case a second
section was made lower down, but only to find the shaft in the
same diseased condition. In Cases II. and Y. the end of the
shaft became extensively eroded; after some time the original
incision was reopened and an attempt made to find the limit
of the disease, but after exposing two or more inches of the
shaft, the bone pi"esented the same external appearance, and
on section the central portion exhibited the same diseased
condition as at the point of first division. In Case lY. the
whole femur was removed through the original incision made
for exsection of the head. On examination, after removal, the
whole bone was of a dirti/ leaden color and very light / it re-
sembled a bone from which .the periosteum had been removed
by maceration ; the foramina for the vessels, to the naked eye,
did not seem increased in number or size. The periosteum
was not intimately attached to the bone at any point, but
seemed simply to envelop it. Thei*e was no bleeding either
from the periosteum or bone, nor was there any pus between
them.
There had been no attempt at bony formation either in
the periosteum (involucrum) or bone (osteophytes). On longi-
tudinal section, after being macerated and dried, the medul-
EXSECTION OF THE HIP-JOINT. 465
lary cavity was found to be greatly enlarged at the expense
of the compact tissue. At the upper part the cavity is filled
with cancellous tissue for the distance of one Purchase Phenytoin Online and a quarter
inch, it then gradually becomes less, until it almost disappears
at about the middle of the shaft, and is then only seen in tufts ;
the compact tissue is very mucli thinned, being reduced to a
mere shell as it approaches either extremity of the bone,
being slightly thicker in the middle, where its greatest thick-
ness amounts to only one or two lines. The medullary
cavity in many places is perfectly smooth, and has a glazed
appearance ; what remains of the compact tissue seems, to the
naked eye, normal, with the exception that here and there it
has a worm-eaten appearance, as though a number of Haver-
sian canals had become enlarged, showing a tendency of the
hard structure to assume the appearance of cancellous tissues.
On microscopic examination of a longitudinal section, it pre-
sents the appearance of healthy bone. At the lower end the
bone has a worm-eaten appearance, and a portion of it has dis-
appeared. The weight of the shaft, after drying, is about two
drachms and a half. The periosteum, which Order Phenytoin Online was removed

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