第20章

Dislocation at the hip-joint occurs in four modes,inward most frequently,outward next,the others of equal frequency.The symptoms:-The common,a comparison with the sound leg.The peculiar symptoms of dislocations inward;the head of the bone is felt at the perineum;the patient cannot bend his leg as formerly;the limb appears elongated,and to a great extent,unless you bring both limbs into the middle space between them in making a comparison of them;and the foot and the knee are inclined outward.If the dislocation has taken place from birth,or during one's growth,the thigh is shortened,the leg less so,and the others according to the same rule;the fleshy parts are atrophied,especially on the outside.Such persons are afraid to stand erect,and crawl along on the sound limb;or,if compelled,they walk with one or two staves,and bear up the affected limb;and the smaller the limb so much the more do they walk.If the accident happens to adults the bones remain of their proper size,but the flesh is wasted,as formerly described;the patients walk in a wriggling manner,like oxen;they are bent toward the flank,and the buttock on the uninjured side is prominent;for the uninjured limb must necessarily come below that it may support the body,whilst the other must be carried out of the way,as it cannot support the body,like those who have an ulcer in the foot.They poise the body by means of a staff on the sound side,and grasp the affected limb with the hand above the knee so as to carry the body in shifting from one place to another.If the parts below the hip-joint be used,the bones below are less atrophied,but the flesh more.