AMPUTATION AT THE HIP JOINT FOR MORBUS 
. COXvE; WITH A CASE AND A SPECIMEN.1 
BY DONALD MACLEAN, M.D., 
OF DETROIT, MICH. 
The points which I desire especially to enforce by 
the following case are: 
First.—That there are cases of hip joint disease 
which, though utterly desperate so far as all the ordi- 
nary procedures are concerned, may still be rescued 
and restored to health by the extreme measure of 
amputation at the hip joint. 
Second.—That the operation of resection, if per- 
formed at all, should be performed at a much earlier 
stage of the disease than has hitherto been customary. 
Third.—That with proper precautions, the opera- 
tion of amputation at the hip joint for disease is a 
safe and satisfactory procedure. 
Case.—C. S. B., aet. 17, from Muncie, Ind., came 
to my public clinic at the University of Michigan 
January 5 of the present year, and in response to 
inquiries made the following statement: 
Eight years ago, he fell on the ice and sustained a 
contusion of the left hip. Still, it was not until the 
following winter that he became so much disabled as 
to require the aid of a cane in walking. Liniments 
and electric baths were prescribed at that time, but 
of course they did not do any good. Two years 
later extension by means of the weight and pulley was 
resorted to, also an extension splint, but in spite of 
these very judicious and rational measures the disease 
continued to progress. 
1 Read before the Surgical Section of the American Medical Asso- 
ciation, at the Thirty-Seventh Annual Meeting. 2 
Eighteen months ago an abscess formed in the 
region of the trochanter major and was opened. 
Before long an abscess formed on the inner aspect 
of the thigh and was opened. From these ab- 
scesses sinuses resulted, which have continued to 
discharge ever since. At the time of his admis- 
sion into the University Hospital, the discharge 
from these sinuses was not extremely profuse, but 
it was intensely fetid. He was greatly emaciated, 
and suffering from marked hectic symptoms. The 
thigh was flexed to a right angle with the trunk, and 
there was no movement discoverable in the hip joint. 
The knee joint was also flexed and partially anchy- 
losed. All the muscles of the limb were contrac- 
tured and atrophied. Under these circumstances 
resection of the joint was at once and for obvious 
reasons excluded. In short, it seemed that the choice 
lay altogether between one or the other of the two 
following alternatives: 
First. Expectancy, which of course promised only 
speedy exhaustion. 
Second. Amputation at the hip joint, and this 
operation commended itself to my mind as a justifi- 
able and even hopeful expedient, provided, first, that 
the pelvic bone should on examination prove to be 
fairly healthy—that is to say, not too far involved in 
the carious affection; and second, that the general 
powers of the patient’s constitution had not been too 
thoroughly undermined by the long-standing and ex- 
hausting disease. The proposition having been fully 
explained to the patient (a most intelligent young 
man), he eagerly assented and placed himself in my 
hands. 
The final decision as to the condition of the os 
innominatum was reserved till the time of the oper- 
ation, and had it been found too far diseased the 
completion of the operation would have been aban- 
doned as useless and unjustifiable. Fortunately, no 
such reason for the the abandonment of the operation 3 
was met with. The disease was confined entirely to 
the acetabulum, and even there was quite superficial 
and small in extent. 
So far as the strain on the patient’s weakened pow- 
ers was concerned I succeeded in convincing myself 
that, provided due precautions against haemorrhage 
and shock were used, he would be able to weather 
the storm. With this object in view I determined to 
use a simple and somewhat primitive form of aortic 
compressor: an instrument made under my own di- 
rections some years ago by a common blacksmith, 
and which has afforded me indispensable aid in a 
considerable number of instances. 
The operation was performed on March i, 1886, 
under chloroform. Hardly a drop of blood was lost. 
The patient was only a few minutes on the table. 
The degree of shock was very slight. 
The wound was treated antiseptically throughout 
and healed rapidly, so that on April 9 the patient was 
able to return to his home in a better state of health 
than he had known for several years. Reports re- 
cieved up to the present time have been altogether 
favorable. I now present for inspection by the mem- 
bers of the Section the femur of this patient. It will 
be observed that the disorganization of the medullary 
canal extends from the one end of the bone to the other. 
Also, that the head of the bone is very nearly all ab- 
sorbed away. A single glance at this specimen is 
sufficient to determine effectually the question of the 
propriety of the operation; or at least the utter hope- 
lessness of the case without this measure. 
Finally, I think we may safely deduce from this 
case the general principle that if resection of the hip 
joint is to afford permanent satisfaction, it must be 
performed at a much earlier stage of the disease than 
has heretofore been customary; that is to say, while 
the disease is limited to the head of the bone, and 
before the medullary canal of the femur has become 
involved, which it is certain sooner or later to do.