HIP-JOINT DISEASE; HIP DISEASE-The disease of children commonly called hip disease is usually an inflammation of the hip joint caused by the germ of tuberculosis or consumption. It begins slowly, and sometimes may apparently be traced to an injury, as a fall or blow. The first symptom which attracts attention to the disease in the child is usually a slight limp and stiffness of the affected limb in the morning, which may pass off after a while when the child is playing. Sometimes there may be periods of weeks when this disappears only to return in a worse form. More often, however, it is constantly present and grows worse. Along with the lameness, or a little later, appears pain. But the pain at first is not as a rule in the diseased hip joint, but in the toe, calf of the leg, or knee. This is apt naturally to mislead parents into thinking the trouble is due to the misnamed growing pains, rheumatism, or weakness in the knee, but they must avoid this error. At night the child often cries out in pain. The position in which the child holds the affected leg is often characteristic. The weight is chiefly borne on the sound limb, while the diseased limb is bent slightly at the thigh, and the toes and limb are turned outward. At the same time the crease, naturally present under the buttocks, is less noticeable on the leg of the affected side. If the physician's attention is called to it in the beginning, most every case can be cured by rest in bed, splints, and apparatus of various kinds. If neglected till a late date, abscess about the joint; years of suffering, permanent crippling and lameness, loss of the limb, or even death may result. BOWLEG.-Most babies appear to be bow-legged at birth, as they have a tendency to bring the soles of their feet together, causing the legs to bow outward. This condition disappears as the baby grows older, although occasionally a child is born really bowlegged. Bowlegs more often develop, however, between the ages of one and six, and are usually due to rickets (see p. 423). The condition may also be seen in robust, heavy children who have been allowed to walk at too early an age. In bowlegs the lower limbs are bent in most cases outward, so that the knees are widely separated. The bowing may be either of the two bones of the leg, below the knee, or of the thigh bone as well, above the knee. About one person in five is said to be bow-legged, and while the condition causes no physical disability or discomfort, yet it is often a repulsive deformity. Treatment. Children having a tendency to bowlegs should not be permitted either to walk or stand at an early age. The avoidance of thick diapers—— which prevent the child from holding its thighs together-is important. Massage-that is rubbing the legs and kneading the muscles-and making gentle and continued pressure on the outside of the limbs, so as to bend them inward into a straight line, will correct the deformity in infants, if done persistently several times daily. When bowlegs first develop in babies, treatment directed against rickets is usually desirable; the child must remain outdoors as much as possible; the diet should be improved; one-half to one teaspoonful of an "emulsion of cod-liver oil with hypophosphites" may be given three times daily, and pure cod-liver oil rubbed all over the body once daily after the bath. If the soles of the shoes are made thicker along the outer borders it will favor correction of bowlegs, when the child begins to walk. In older children, when bowlegs are very pronounced, and the deformity is of long standing, correction can only be secured through the application of apparatus by the surgeon, or through operation, such as cutting loose part of the bones of the thighs and setting them in proper position. KNOCK-KNEES.-This is a deformity acquired in infancy, owing to rickets-with malformation of the bones of the legs-but may develop in later life, owing to weakness of the ligaments on the inner side of the knee joint. In knock-knee, the knees are in close contact, and the feet held apart. A slight degree of this condition is seen naturally in women. Knock-knee is not recognized by parents so readily as bowlegs. After the child has begun to walk, it may show the trouble by an awkward, waddling gait, and by frequently stumbling and falling, and the deformity may be seen when the child is standing erect or lying with the legs stretched at full length. The deformity does not tend to correct itself, as in the case with bowlegs. The treatment with cod-liver oil and outdoor life, advised for bowlegs, is appropriate for knock-knee in infancy. Also the legs should be well rubbed and kneaded, and straightened by pressing upon the inside of the knee joints with the palm of one hand, while the ankle is grasped with the other. Such treatment should be employed for ten minutes at a time twice each day. If such measures do not correct the deformity, it will be necessary for a physician to apply braces, which will usually cure the condition in children under six. After this age an operation to break or cut the bones above the knee is often required to secure a good result. |