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1 From the "Records of the Bellevue Hospital," 1860 to 1882. From the "Records of the New York Hospital," 1877 to 1882.
* From the "Records of the Chambers Street Hospital" (imperfect), 1875 to 1882.
It will be seen that, of the 273 reported cases, 184 were reduced, 68 remaining unreduced; 27 per cent were therefore failures, and in 67 per cent, the operation was successful.
There were, so far as could be determined from the data furnished, 130 males and 53 females. The number of dorsal dislocations was 168. There were reduced 100, and unreduced 49, or, respectively, 67 and 32 per cent. The ischiatic dislocations, numbering 39, gave 5 unreduced cases, or 13 per cent.
The 25 thyroid luxations gave 4 failures, or 16 per cent, and the pubic dislocations, numbering 10, gave 2 unreduced cases, or 20 per cent.
The statistics show that 19 patients were between the ages of one and ten years; 22 between ten and twenty-five years; 23 between twenty-five and forty years; and 18 between fiftyfive and eighty years. In one report of 91 cases, the ages were generally stated to have varied from five to forty-five.
Among the cases reduced we find 113 perfect recoveries
against 20 that were imperfect; the latter being complicated by previous disease or fracture.
CONCLUSIONS.-1. The order of frequency for the four dislocations of the hip, as shown by the statistics of this paper, is, respectively-first, the dorsal; second, the ischiatic; third, the thyroid; fourth, the pubic.
2. The signs are so well marked in the dorsal luxations that this form can be readily diagnosticated.
3. The diagnosis was clearly made in the majority of the ischiatic dislocations, while, in a majority of the cases, the deformity was so slight, and the impairment of function so trifling, as to give rise to the opinion that no dislocation existed.
4. The treatment by manipulation or flexion is the most successful in recent luxations.
5. Traction or rotation, added to flexion when the latter failed alone, proved successful in several cases.
6. When extension and counter-extension are used, their efficacy will be enhanced by association with the necessary manipulations, chief of which is flexion of the femur at a right angle with the pelvis during the extension. The merits of this plan of treatment are demonstrated by its success in the recorded cases in the table.
7. In some cases of failure to restore the head of the bone to its socket, owing to the small aperture in the capsule, this orifice was enlarged, and the reduction was at once accomplished by circumduction of the flexed thigh.
8. In every reported case of dislocation of the hip, complicated by fracture of the acetabulum or of the neck of the femur, there was failure to reduce or an imperfect recovery, so that, if either of these conditions be known to exist, it would rarely be expedient to attempt reduction.
9. Reduction is more generally effected now than it was forty or fifty years ago.
In conclusion, I may ask whether my statistics show a larger proportion of unreduced dislocations of the hip than is necessarily incident to this accident. If this be true, it is an admission that surgery has achieved less in this than in other fields
of labor. May not the large percentage of failures to reduce these dislocations be referable to errors in diagnosis or in the treatment adopted?
I suggest these questions, hoping that the figures presented may provoke a spirit of studious investigation in many surgeons who, attaining complete mastery of hip-joint surgery, will thereby greatly increase the proportion of cases of successful reduction. The rare occurrence of dislocations of the hip should warn us to keep our anatomical knowledge fresh by frequent dissections of the joint, in order that the phenomena of its luxations may, when encountered, be promptly and correctly interpreted. The ability to reduce a dislocated hip of weeks' or months' standing is creditable to the surgeon; but how far this ability will atone for failure to detect the nature of the case when recent, and to restore the head of the bone at once to its socket, while the latter is able to receive and to retain it, is a question which must be left for individual decision.
CHRONIC INTESTINAL CATARRH.
By JOHN S. JAMISON, M. D., of Steuben County.
THERE are few diseases which come more frequently under the observation of the general practitioner of medicine than those which affect the organs concerned in digestion; and one of the most important of this class of affections is chronic intestinal catarrh. The processes of intestinal digestion in health and their modifications in disease are not so well understood by many practitioners as they should be, in view of the importance of many of the disorders which affect the intestinal tract; and mere medication, unassisted by a judicious regimen, is usually unequal to the task of successfully combating the diseases to which this part of the digestive system is subject.
A large percentage of cases of intestinal catarrh that come to the notice of the practitioner, which are difficult to diagnosticate, occur in persons in civil life, beginning with a diarrhoea of moderate severity, followed by weakened digestion and constipation alternating with slight diarrhoea, with anatomico-pathological changes in the intestines, involving but a small local
ETIOLOGY.-The exciting causes of acute intestinal catarrh are very many; and, in civil life, the ætiological factors depending upon improper diet are the most frequent. Food of bad quality or improperly cooked; an excessive quantity at a meal,