mes several weeks later and in the case of very slow
development of tubercularly inflamed hip-joint several months later. In
very small children the attendance of pain is manifested by the fact
that they will not play and they often wake up in the night and begin to
cry.

Children from the fourth and fifth year upward definitely point out the
hip as the seat of pain, sometimes, however, the knee-joint on the
diseased side is designated with great determination. This pain in the
knee has often been the cause of mistakes.

Later on painfulness of the hip-joint is experienced from pressure and
at about the same time the movements are impeded.

Then the leg takes a peculiar position. The thigh is slightly bent and
rolls outward. For convenience the child drops the half of the pelvis
corresponding to the diseased hip-joint, and naturally raises the other
half. From this apparently a curvature of the spinal column results in
the lumbar region. Apparently only, for when the child is laid down and
the morbid position of the thigh is restored the curvature of the lumbar
column disappears.

During the further progress of the disease the pain is increased, and
the sensibility may become so acute that the slightest movement of the
limb, even a shaking of the bed in which the patient lies will cause the
most intense pain. In the previous stage walking could only be done for
short distances and then awkwardly, now it is entirely impossible.
Children are obliged to lie in bed night and day, and under these
altered conditions there is a change of the position of the extremity.
The increased sensibility induces the child to seek the medium position,
the leg is bent more than in the position mentioned above, it is halfway
straightened.

To this is added, that the child can not lie well on the sensitive and
swollen hip; with right side hip-joint inflammation it turns on the
left. As the diseased and bent thigh does not then rest on the mattress
the same is placed on the healthy limb for support and for protection
from movements, in the same manner as we lay one leg on the other in a
healthy condition when we sleep on our side.

The actual danger to life in tuberculous hip-joint inflammation begins
with the time when the child takes to his bed. The fatal end comes
almost without exception after suppuration has commenced, very rarely
before that time. Total suppuration of the hip-joint is an almost
absolutely fatal process. If this s