EXSECTION 
Of THE f / * 
HEAD OF THE FEM PR, 
AND REMOVAL OF THE 
UPPER ULM OF THE ACETABULUM, 
FOR 
MORBUS COXARICS. 
. * •, . aH3?8Sfcs^ 
B? 
LEWIS A SAYRE, M.D, 
SURGEON TO BELLEVUE HOSPITAL J PROSECTOR IN SURGERY IN TUB COLLEGE OF PHYSICIANS 
AND SURGEONS; MEMBER OF THE PATHOLOGICAL SOCIETY, AND MEMBER OF THE 
NEW YORK ACADEMY OF MEDICINE, ETC., ETC. 
(From the New York Journal of Medicine, for January,18550 
• 
N E W Y 0 R K. 
HOLMAN, GRAY i CO.. PRINTERS, CORNER CENTRE AND WHITE STS. 
1854. 
a EXSECTION 
OF THE 
HEAD OF THE FEMUR, 
AND REMOVAL OF THE 
UPPER RIM OF THE ACETABULUM, 
FOR 
MORBUS COXARIUS. 
BY 
LEWIS A. SAYRE, M.D., 
'O * 
SURGEON TO BELLEVUE HOSPITAL; PROSECTOR IN SURGERY IN THE COLLEGE OF PHYSICIANS 
AND SURGEONS; MEMBER OF THE PATHOLOGICAL SOCIETY, AND MEMBER OF THE 
NEW YORK ACADEMY OF MEDICINE, ETC., ETC. 
(From the New York Journal of Medicine, for January, 1855.) 
NEW YORK: 
HOLMAN, GRAY & CO., PRINTERS, CORNER CENTRE AND WHITE STS. 
1854. EXSECTION 
OF THE 
HEAD OF THE FEMUR 
AND 
REMOVAL OF THE UPPER RIM OF THE ACETABULUM, 
FOR 
MORBUS COXARIUS. 
On the 20th of March, 1854, I was called, in consultation 
with Dr. Throckmorton, to see Ellen G., 297 Fifth street, 
aged 9 years, who had been suffering for 18 months with 
morbus coxarius of the left hip, which was supposed to have 
resulted from a fall. She had been treated with issues, blis- 
ters, etc., together with the general tonic and anti-scorbutic 
r remedies adapted to such cases; but the disease continued 
to progress, until an abscess was discovered, involving the 
whole upper front and inner portion of the thigh, accompa- 
nied with repeated chills, profuse sweats, and great pros- 
tration. 
When I first saw her, this abscess had pointed in two 
places, and was apparently just ready to open; the point 
nearest the surface and most fluctuating was just by the 
anterior superior spinous process of the ileum, immediately 
in contact with the attachment of the tensor vaginas femoris 
muscle, and Poupart's ligament. The other place of point- 
ing was about five inches below the ligament, just over the 
femoral artery; pressure on any part of the upper portion 
of the limb distended both of these pointing abscesses, show- 
ing communication between them. 4 
The leg was shortened inches, and turned inward, 
but. not permanently fixed in its position, (as is usual,) but allow- 
ing of considerable motion, which gave a distinct bony crepi- 
tus between the femur and ileum. The pelvis was twisted 
and drawn upwards. Her general health had become much 
affected, having lost her appetite, and she was suffering from 
hectic, with constant chills and profuse sweats, and was only 
rendered comfortable by the constant use of anodynes. 
I advised a free opening of the abscess, and, if necessary, 
to remove the head of the femur. At first this was objected 
to ; but, as the child's health rapidly failed and death seemed 
inevitable, the father, in a few days, consented to the opera- 
tion. Accordingly, on the 29th of March, 1854, assisted by 
Drs. Throckmorton, Drake, Thebaud, Bauer, and Bertholf, 
I proceeded to perform it. 
I first laid open the abscess by a free incision of about six 
inches, over the trochanter major, on the outer aspect of the 
thigh, and in a line with the femur, and then cut into the 
floor of the abscess (which principally occupied the inner and 
front portion of the thigh), and discharged about a pint of 
thin serous and flaky pus. The finger was then readily 
passed around the neck of the femur, and detected an open- 
ing in the capsular ligament on the inner surface of the 
neck. The upper border of the acetabulum had been 
absorbed, and the head of the femur was upon the dorsum 
of the ileum, near the anterior superior spinous process, sur- 
rounded by its capsule, (which seemed to have been slipped up), 
and a large deposit of bone, apparently being an attempt of 
Nature to make a new acetabulum. But this cavity thus 
formed had no lining membrane, as the femur grated roughly 
upon it. I then opened the capsular ligament on a line with 
the external incision, and disarticulated by bringing the leg 
strongly across the opposite thigh, and then, with a large 
pair of Luer's forceps, readily cut off the head of the femur 
at the lower extremity of the neck. The bone at this point 
appeared pefectly healthy. I was very cautious not to 
injure the insertion of the psoas-magnus, or iliacus-internus, 5 
or any of the rotator muscles, which are inserted just behind 
the trochanter major. 
The upper rim of the acetabulum had been absorbed, 
(according to the theory of Dr. March, of Albany,) and the 
new deposit of bone, which was intended to supply its 
place, was denuded and carious. I gouged it off with a 
sharp, firm chisel, made for that purpose, and, in this way, 
took off a number of flakes of bone, until I came to a heal- 
thy, bleeding surface. 
The anterior superior spinous process on its outer surface, 
and the external lip of the crest of the ileum, was black 
and carious for some distance, and with the forceps I easily 
clipped it off until I came to healthy bone. Very little 
blood was lost in the operation, and after cleaning away all 
the debris, I brought the leg in the straight position, filled 
the wound with lint, and dressed with a roller and cold 
water compress. She was then put to bed, and a cup of 
strong coffee administered, after which she soon fell asleep. 
The child was under the influence of chloroform during 
the operation, 'which occupied nearly 20 minutes, and was 
perfectly insensible the whole time. 
The following extracts from my note book, taken at each 
daily visit, exhibit the progress of the case : 
11P.M.-Has slept occasionally and is quite comfort- 
able ; pulse 128 ; skin good; vomited freely about 4 P. M. 
March 30, 10 A. M.-Passed a good night, without any 
narcotic, and slept about four hours; has had no chill; taken 
breakfast with a relish, and is surprisingly comfortable, 
considering the magnitude of the operation; pulse 120; no 
hemorrhage; passed urine twice. 
March 31.-Took half a grain of opium last night; slept 
well; pulse 120; skin good; removed external layer of 
lint; found small amount of pus. 
April 1.-Slight fever; heat of skin and thirst; pulse 
130. Administered 5 gr. Dover's powder, with addition of 
half a grain ipecac., every four hours. 
April 2.-Tias passed a good night, slept six hours, ate a 6 
good breakfast, and feels every way better, but is much 
more feeble; dressed the wound; on removing the lint, 
found healthy pus in abundance. 
The abscess, which pointed at the anterior superior 
spinous process, being again full and fluctuating, I opened 
it, and gave exit to about a tablespoonful of tolerably 
healthy pus; pulse 140, and more feeble; directed to 
administer brandy and beef-tea more liberally; I do not 
think the family give sufficient stimulant or nourishment, 
as they are very strongly opposed to brandy, and are afraid 
of meat on account of fever. 
April 3.-Slept well all night without opiate ; pulse 120; 
bowels moved twice naturally; appetite good ; finding great 
improvement, follow a more nutritious diet; I advised its 
continuance. 
April 4.-Same as yesterday; healthy suppuration, rather 
abundant. 
April 5.-Child very comfortable, amusing herself by 
cutting paper dolls; applied the straight splint for counter 
extension to the well side, and made extension by means of 
the foot-board, bringing the limb down to the same length 
of the opposite one. 
April 6.-Slept well; bowels moved naturally ; but pulse 
more quick and feeble, 160 ; has not eaten so well; ordered 
brandy and soup to be given more liberally. 
April 1.-Slept well, but much weaker, having had three 
loose discharges in the night, and some hemorrhage from the 
nose, which was arrested by astringents and compress. 
Ordered brandy and laudanum, with more liberal use of iron. 
April 8.-Diarrhoea not yet checked; the brandy and 
opium was not given, and yet the child is somewhat stronger 
than yesterday ; pus more consistent. 
April 9.-Diarrhoea checked; slept well; eats freely ; 
discharge less copious and more consistent; pulse 120. 
April 10.-Very comfortable; looks as if it will require 
a counter-opening on the front of the thigh, at the old place 
of pointing. 7 
April 13.-Doing well, and the wound filling with healthy 
granulations. 
April 14.-I applied a compress and adhesive straps on 
the inside of the thigh. 
July 1.-Dr. Throckmorton has seen the child daily since 
my last visit, and reapplied the bandage and compress, 
which has had a most salutary effect, and the abscess has 
the appearance of healing rapidly. 
July 10.-I was again called to meet Dr. T. to-day, and 
found the child much prostrated from a severe attack of 
dysentery, which had lasted four or five days ; she is very 
much reduced, and, I fear, will not rally. The granulations 
are flabby, and pus thin and copious. 
August 1.-The dysentery has been checked for some 
days; but the wound, which was nearly closed, has opened, 
and a small piece of ragged bone came away, which was 
probably some portion of the shavings or chips removed 
from the ileum, at the time of the operation, and which I 
had not been sufficiently careful to remove.* 
August 20.-The child very much improved, but the 
fistulous opening, from which the piece of bone had 
escaped, remaining, and having rather a white and flabby 
appearance, I injected it with tinct. iodine. 
August 24.-The injection has been followed by a smart 
attack of erysipelas, which has extended down some dis- 
tance below the knee, and there is considerable constitu- 
tional disturbance. 
Sept. 1^.-The erysipelas gradually subsided, but seems 
to have been of great service, as it has caused union of the 
walls of the abscess all around the thigh, and the small open- 
* Since making this note, my impressions have been more confirmed, as two 
similar pieces of bone have been removed from different parts of the cicatrix, 
and have thus materially retarded the progress of the case ; I should therefore 
advise great care, after the performance of this operation, that all debris and 
foreign bodies be carefully washed from the wound ; and in so large and rag- 
ged an abscess as this one was, it will require more care than any one would 
imagine, unless they had seen it 8 
ing in the cicatrix is nearly closed, discharging a very few 
drops of healthy pus. The limb is ^ill in the extending 
splint; but on removing it there seemed no tendency to 
retraction of the limb. The splint was reapplied; but the 
body was left free from the bandage, so as to allow of 
flexion in order to prevent anchylosis. 
I might here mention, that for some weeks past, since 
about the 1st of August, at each dressing her body has been 
brought at a right angle with the thighs, having this object 
in view; and I have now permitted her to do it as often as 
she likes. 
Nov. ls£.-I had not seen the case for two months, until 
to-day, when, to my astonishment, I found her walking on 
her crutches, which she has been able to do for some two 
weeks. Her limb appears the same length as the other, and 
she can flex and rotate it freely. I directed her to bear no 
weight upon it yet. 
20th.-To-day I placed her in the horizontal position, and 
measured her carefully, and find there is about £ or nearly 
1 of an inch shortening. By taking hold of the foot, the 
whole body can be drawn down in bed without pain in the 
joint, and a pressure may be made sufficiently strong to move 
the pelvis and body upward without producing any shorten- 
ing of the limb. When she lies upon the back, with the leg 
extended upon the thigh, she can elevate the heel sixteen 
inches from the bed, and flex the knee so as to bring the 
thigh at a right angle with the pelvis; she can rotate it 
internally so as to touch the other foot, and externally so as 
to touch the bed. Her general health is perfect, and the case 
has terminated perfectly successfully. I feel in duty bound to 
express, in this place, my warmest thanks to Dr. Throck- 
morton, for his constant care and attention of this interesting 
case, and to which I am confident I am greatly indebted for 
so successful a result, as the distance from my house rendered 
it impossible for me to give it the care required. 
The bone was carefully examined, microscopically, but no 
trace of tubercle was found. 9 
Remarks.-The history of exsection of the head of the 
femur in hip-joint disease lies within the present century. 
The first surgeon who suggested the possibility of exsection 
of this bone, was Mr. Charles White, in 1769; but the first 
to attempt its performance, in morbus coxarius, seems to have 
been Schmalz, in 1816. In this case the head of the bone 
was found loose, and simply required removal; but it was, 
on this account, no less a case of exsection in this disease, 
and its successful results add much interest to the early 
history of the operation. In 1818, Anthony White performed 
his celebrated operation, which has generally been referred 
to as the first successful attempt to exsect the head of 
the femur in morbus coxarius. It seems to have been 
repeated in Great Britain but once, and then by Hewson, of 
Dublin, until 1845, when Mr. Fergusson operated successfully. 
Since this date it has been very frequently performed in 
England; and within the last year we find notices of three 
operations in the London Hospital. Mr. Fergusson has ope- 
rated five times, and, as far as we can learn, with uniform 
success; one patient died two years after the operation of 
" of enlargement of the liver, after having experienced great 
relief from the proceeding." 
Mr. Fergusson states {Med. Chir. Trans., vol. 28), that he 
has learned that Mr. Brodie performed this operation, and 
" the patient died within a few days after, the direct effect 
of that proceedingbut Mr. Henry Smith, writing in 1848 
{London Lancet), remarks that he has not been able to 
"obtain any accurate information respecting the correct- 
ness of this assertion." There is no doubt that this sur- 
geon did exsect the femur at St. George's Hospital, about 
the year 1836, but under what circumstances it does not 
appear. 
In this country this operation seems to have attracted little 
attention. A case is reported in the W. Y. Med. Surg. Re- 
porter, Jan. 10, 1846, in which Dr. J. P. Batchelder, of this 
city, removed the head of the femur in 1845, under the fol- 
lowing circumstances : A young man was kicked by a horse 10 
upon his hip, four or five years before, which gave rise to severe 
symptoms: fistulous openings formed and discharged pus free- 
ly ; the probe finally detected dead bone; the fistula was dilated 
with sponge tents, and the dead bone removed with forceps, 
which proved to be the head of the femur; the patient now 
rapidly improved and eventually recovered. 
I have learned that Dr. Parkman, of Boston, exsected this 
bone in 1853, but the particulars and results of the case I 
have no knowledge of. Dr. Bigelow, of the same city, ope- 
rated soon after, but the case terminated fatally. From a 
somewhat extended examination of our medical periodicals, I 
have been unable to find records of any other case. 
By a careful examination of the accompanying table, I 
think the propriety of the operation will be admitted. We 
might maintain its importance, also, from the fact that it is but 
following the indications of Nature. The cases of Schmalz 
and Kluge, in which the head of the femur was found sepa- 
rated from the shaft, are examples of natural efforts to remove 
the foreign body. Two striking instances of this kind were 
reported to the Dublin Pathological Society, in 1839, by Dr. 
Carlile, who exhibited two specimens of the epiphyses of 
the femur, which had been spontaneously discharged in two 
cases of hip-disease. One patient was 20 years of age, the 
other 5 ; both rapidly and completely recovered. 
In preparing the following table, regard was had to ex- 
section only in morbus coxarius, as it is in reference to this 
particular class of cases that we wished to estimate the value 
of the operation. To arrive at the most satisfactory con- 
clusion in regard to the propriety of the operation, each 
case ought to be carefully examined, and the complications 
duly considered. It will be sufficient, however, for our pur- 
pose, to notice briefly the fatal cases, and, as far as given, the 
causes of death; by these means we can estimate the part 
which the operative proceeding bore in the fatal issue of the 
several cases. 
Hewson's Case.-Profuse suppuration; died three months 
after the operation; extensive disease of the cotyloid cavity 11 
found, with perforation of the acetabulum and formation of 
abscesses in the pelvic cavity. 
Textor's first Case.-Sloughs formed on the sacrum ; died 
on the 53d day after the operation; on examination, the 
wound was found nearly cicatrized; there was the com- 
mencement of a false joint, consisting in bony deposits on 
the femur, and a depression on the ileum. 
Textor's second Case.-Gangrene of the wound took place, 
and the patient died on the 4th day. 
Fergusson's Case.-Died two years after, of enlargement of 
the liver; wound never entirely healed, owing to a piece of 
necrosed bone from the edge of the acetabulum, which the 
trochanter major prevented from escaping. The operator 
remarks: "I left the trochanters,being under the impression 
that by taking away the diseased head of the femur only, 
I lessened the danger, but it was found in the after treat- 
ment, that the trochanter major so projected outward in the 
line of incision as greatly to retard the closing of the 
wound, and I had no doubt, on inspection after death, that 
it had acted as a kind of cap to the acetabulum, and pre- 
vented the necrosed portion of bone, above referred to, from 
getting out." * 
Roux's Case.-Secondary hemorrhage ; died on 7th day ; 
post-mortem examination revealed a. large collection of pus 
between the glutei muscles; extensive disease of the coty- 
loid cavity ; extensive disease of femur below its section; 
pus in the medullary cavity, disease of pubic bones. 
Simon's Case.-Particulars of this case not given. 
Smith's Case.-Progressed favorably for a time ; symptoms 
of Bright's disease made their appearance, and he died four 
and a half months after the operation. Kidneys found in 
an advanced stage of Bright's disease; sinuses were found 
extending upwards along the psoas muscles and originating 
in caries of the upper lumbar vertebrae. 
* We do not learn that he used any extension-if so, this ought not to 
have happened. 12 
Hawkins' Case.-Patient very much exhausted; suffered 
little by the operation; died on 3d day. On examination 
the acetabulum was found perforated so as readily to admit 
the passage of the finger. 
Bigelow's Case.-Particulars not given. 
Ericksen's Case.-^-Particulars not given. 
It will be seen that, as far as the particulars of these 
fatal cases are given, death was attributable in most instances 
to some grave complication. The operation has almost in- 
variably produced the most favorable change in the general 
symptoms of the patient, and, in several fatal cases, the parts 
involved in the operation have healed in the most satis- 
factory manner, when at length the patient has succumbed 
to some new and acute disease. 
By a careful examination of the tabulated cases, the 
propriety of the operation must be admitted, and also the 
great importance of not neglecting it too long, lest the 
constitution become so exhausted as not to rally from the 
shock, or sink from excessive suppuration. By too long 
delay, also, the acetabulum may become so much involved as 
to render the operation useless. 
So soon as suppuration is formed in the joint, and the 
synovial membrane has been destroyed, which can be as- 
certained by fluctuation and crepitus, I should advise a free 
incision to be made into the joint, just posterior to the tro- 
chanter major, to give free exit to the pus. Extension 
should then be made, after the plan proposed by Prof. 
March, of Albany-otherwise the bones of the pelvis may 
become seriously involved. From personal experience in 
opening suppurative joints, I am satisfied that there need be 
no fear from the admission of air, which has always been so 
much dreaded. This fear has, doubtless, arisen from the great 
constitutional disturbance which follows its introduction into 
healthy joints, but we must recollect that after suppuration 
and destruction of the synovial membrane, that it has in fact 
no longer the characteristics of a joint, but is the same as any 
other abscess connected with bone, and should be treated 13 
upon the same general principles. By this prompt treat- 
ment in the earlier stages of the suppuration, we will avoid 
the necessity of exsection, and in the majority of cases have 
a speedy recovery with tolerable motion, and in many in- 
stances perfect and complete. Two such cases have occurred 
in my own practice, and I have seen a number in the practice 
of my friends. But as I did not intend to speak of suppura- 
tion of the joints in this paper, but simply of exsection for 
caries or necrosis, I will postpone the further consideration of 
this subject, merely remarking, that if we will carefully 
study the fatal cases which I have reported, I think we 
cannot but infer, that had the plan proposed been earlier 
pursued in those cases, we might have anticipated a more 
favorable result, at least, in some of them. 
Summary.- Whole number, inclusive of above case, 30. 
Recovered, 20.-Of these, 13 were completely successful; 
3 died of an intercurrent disease, at periods varying from 
three months to two years after the operation; 1 is reported 
as not having progressed favorably ; the remainder were too 
meagrely reported, or too recently performed to decide cor- 
rectly of results. 
Died, 10.-Of these, 4 died within one week after opera- 
tion ; 1 on the 12th day ; 2 in two months; 1 in four and a 
half months ; 1 some months after; 1 unsuccessful. 14 
NO. & SEX 
AGE. 
CAUSE AND DURATION. 
CONDITION. 
OPERATION. 
PROGRESS OF CASE. 
OPERATOR. 
1 
Caries; head separated from 
shaft. 
1816. 
Recovered. 
SCHMALZ. 
2, M. 
14 
• 
Fall three years before. 
Head dislocated on dorsum 
great exhaustion; several 
fistulas. 
1818; straight incision; straight 
saw ; four inches removed. 
Bandages and splints used as in com- 
pound fracture; fever slight; dis- 
charge soon ceased ; health rapidly 
improved; well in a year; perfect use 
of limb, except in rotating knee in. 
White. 
3 
- - 
Caries. 
1823 ; removed above lesser tro- 
chanter. 
Perforation of acetabulum and for- 
mation of abscesses in the pelvis ; 
died in three months. 
Hewson. 
4 
1 
1 
| Caries with abscesses. (1829. 
Cured in 6 weeks; patient able to walk. 
1 SCHLITCHING. 
5 
- 
! 1 Caries ; head loose ; fistulas. 
| |Die.d two months after operation 
Kluge. 
6 
Child. 
, (Caries. 
Recovered. 
Vogel. 
Disease of neck of bone and 
trochanter; head healthy. 
- 
Sloughs formed on the sacrum ; death 
on 53d day ; wound nearly healed 
Textor. 
8 
Caries ; head dislocated. 
Gangrene of wound took p?ace and| 
death followed on the 4th day. 
Textor. 
9 
| 
1845; removed all above lesserlComplete recovery, 
trochanter. 
Textor. 
10, M. 
14 
Some months. 
Head dislocated on dorsum; 
large sinus extending to it. 
1845; straight incision; chain 
saw broke ; used the straight; 
four inches removed. 
Dressed as in compound fracture ; 
shock slight; wouiA healed well; 
health rapidly improved ; limb very 
useful, 2i inches shorter than the 
other. 
Fergusson. 
11, M. 
8 
Some time. 
Head dislocated ; abscess over 
the ileum ; sinuses ; hectic 
and emaciation. 
1847 ; crucial incision ; edges of 
acetabulum removed ; left 
the trochanters. 
Treated as in former case; health 
improved ; wound never entirely 
healed ; died two years after of dis- 
ease of the liver. 
Fergusson. 
12, M. 
15 
Long standing. 
Dislocation; emaciation ; 
cough ; hecti c; no abscess 
or fistulas. 
1847 ; straight incision ; re- 
moved head and part of neck. 
Secondary hemorrhage ; collection of 
pus between glutei muscles ; death 
on 7th day; extensive disease of 
cotyloid cavity. 
Roux. 
13 
Child. 
Two years. 
'lead dislocated on acetabu-11848; removed head and por- 
lum ; sinuses and abscesses., tions of acetabulum. 
Died four days after the operation. 
Simon. 
14, F. 
M1 
Some time. 
lead carious and dislocated!1848 ; head and trochanter re-iRecovered. 1 Frbnch. 
on dorsum. ] moved; acetabulum healthy.' 
15 । 1- ' 
| | Recovered perfectly. [ Fergusson. 
Table of Thirty Cases in which the operation of Excision of the Head of the Femur has been performed in Morbus Coxari^s. 15 
NO. & SEX. 
AGE. 
CAUSE AND DURATION. 
CONDITION. 
OPERATION. 
PROGRESS OF CASE. 
OPERATOR. 
16, M. 
16 
Two years. 
Caries; severe pain ; sinuses 
with discharge. 
1848: straight incision ; re- 
moved four inches and the 
carious part of cavity. 
Dressed as in fracture; pain ceased; 
health rapidly improved ; wound 
closed well. 
Walton. 
17 
18, M. 
33 
Year and a half. 
Hip swollen ; sinus dis- 
charging ; caries. 
1848 ; straight incision ; remov- 
ed three inches of rim of 
acetabulum ; no ligatures. 
Unsucessful. 
Water dressings; fever slight; symp- 
toms improved for four months, 
when leg became oedematous, and 
he died 4| months after the opera- 
tion ; Bright's disease of kidneys, 
and caries of vertebrae found, 
Walton. 
Smith. 
• 
19, F. 
Three years. 
Caries; head dislocated. 
1849; crucial incision; removed 
head and trochanter major. 
Recovered perfectly. 
Fergusson. 
20 
- 
1849. 
Recovered, with perfect motion of the 
thigh, & could walk a short dist'ce. 
Morris. 
21, F. 
12 
-- 
Large open sore on hip ; ca- 
ries ; sinuses ; emaciation, 
etc. 
1849; straight incision; com- 
mon saw ; removed 4| inches. 
Placed in straight position; slight 
fever ; symptoms soon improved; 
ulcers healed ; health gaining. 
Cotton. 
22, M. 
41 
Two years. 
Great suffering, grating in 
joint; large discharge of 
matter. 
1850; made a T incision ; cap- 
sule entire, except at inner 
edge; removed below great 
trochanter; head carious, 
edge of cavity. 
Wound cicatrized rapidly ; severe 
symptoms all subsided; died three 
months after of dysentery, the 
wound being near'y healed: parts 
found in a healthy condition, and 
in an advanced stage of repair. 
Buchanan. 
23 
Caries; head and neck par- 
tially destroyed. 
1851; removed head. 
Wound healed, but abscess formed; 
did not progress very favorably. 
Sayle. 
24, F. 
10 
Several years. 
Feeble and emaciated; fistu- 
las discharging freely. 
1832 ; circular incision; large 
collection of pus under glu- 
teim. 
Symptoms rapidly improved ; made 
extension by weight attached to 
foot; wound healed. 
Stanley. 
1852 ; straight incision ; remov- 
ed one inch below trochanter; 
also edge of acetabulum. 
Progressed favorably two days; died 
on 3d day after operation; found 
large perforation of acetabulum. 
Hawkins. 
25, F. 
10 
Four years. 
Head carious ; emaciation 
and hectic. 
26, M. 
10 
- 
Caries and dislocation. 
1852; bone separated while 
sawing. 
Cold water dressings ; pulse unaltered 
three days; death on 12th day, 
Bigelow. ' 
27, M. 
14 
- 
Greatly reduced; bone dis- 
located. 
1853 ; neck and great trochan- 
ter removed. 
Rapid improvement ; suppuration 
profuse ; died some months after. 
Erichsbn. 
28, F. 
12 
Long standing. 
1854 ; removed head and both 
trochanters. 
Improvement marked. 
Fergusson. 
29, M. 
8 
Long standing. 
Gt.emaciation; hectic, caries. 
1854; removed head and edges 
of acetabulum. 
Recovered. 
Erichsen. 
30 
18 months. 
Gt. emaciation; hectic, caries. 
1854; removed head and edges 
of acetabulum. 
Recovered perfectly. 
Sayre.