llowed to persist, while the disease has undergone cure. It is
associated with ankylosis of the joint, or contracture of the soft
parts or both. The contracture of the soft parts involves specially
the tendons, fasciae, and ligaments on the anterior and medial aspects
of the joint, and is usually present to such a degree that, even if
the joint were rendered mobile, these shortened structures would
prevent correction of the deformity. The usual deformity is a
combination of shortening, flexion, and adduction.

#Bilateral Hip Disease.#--Both hip-joints may become affected with
tuberculous disease, either simultaneously or successively, and
abscesses may form on both sides. The patient is necessarily confined
to bed, and if the disease is recovered from, his capacity for walking
may be seriously impaired, especially if the joints become fixed in an
undesirable attitude. The most striking deformity occurs when both
limbs are adducted so that they cross each other--one variety of the
"scissor-leg" or "crossed-leg" deformity--in which the patient, if
able to walk at all, does so by forward movements from the knees. An
attempt should be made by arthroplasty to secure a movable joint at
least on one side.

OTHER DISEASES OF THE HIP-JOINT

#Pyogenic Diseases# are met with in childhood and youth as a result of
infection with the common pyogenic organisms, gonococci, pneumococci,
or typhoid bacilli. While the organisms usually gain access to the
tissues of the joint through the blood stream, a direct infection is
occasionally observed from suppuration in the femoral lymph glands or
in the bursa under the ilio-psoas.

The _clinical features_ are sometimes remarkably latent and are much
less striking than might be expected, especially when the hip
affection occurs as a complication of an acute illness such as scarlet
fever. It may even be entirely overlooked during the active stage, and
only noticed when the head of the femur is found dislocated, or the
joint ankylosed. In the acute arthritis of infants also, the clinical
features may be comparatively mild, but as a rule they assume a type
in which the suppurative element predominates. The limb usually
becomes flexed and adducted, and a swelling forms in front of the
joint at the upper part of Scarpa's triangle; the upper femoral
epiphysis may be separated and furnish a sequestrum.

The flexion and adduction of the limb favour the occurrence of
dislocation. A child who has