DOI: 10.7925/drs1.ucdlib_280916
title: Chronic rheumatoid arthritis of hip

description: Watercolour medical illustration depicting chronic rheumatoid arthritis in a man. It has the alternative reference number 1776, P13A and 38 on the front. There is no Richmond Hospital Museum reference. The artist's name is in the bottom right corner 'J. Connolly D[]' and the date is cut off but reads 'Sept. 26, 18[]'. The handwritten note in the bottom left corner reads 'Chronic rheumatoid arthritis of hip. Case of Pat.k Mackin Aet 75'. The typescript note on the back begins 'D.e.29 The following case is that of an individual who has been, to the writer's knowledge, suffering for many years under this disease'.
description: Scope and content: The full typescript note on the back reads 'D.e.29 The following case is that of an individual who has been, to the writer's knowledge, suffering for many years under this disease. Patrick Maken, now aged seventy-seven years, was brought up as a postilion and groom, but for the last seventeen years has been quite unfit for service in consequence of his having been afflicted with a very severe pain in [] right hip; from the first attack of which [] came lame, and ever since the lamen[] been slowly but gradually increasing [] respect his health is excellent, except that [] has some wandering rheumatic pains in other joints, particularly in the right shoulder. He walks with great labour and pain, and now requires the assistance of a stick in each hand (fig. 316); in the morning his movements are stiff and confined, but they become freer on exercise; in the evening of a day he has walked much, the pain and stiffness are worse and increased in proportion to the excess of exercise and labour he had undergone in the day. While he remains in bed he rests the affected hip, and suffers no pain whatever except he suddenly turns himself incautiously. As soon as he gets up and throws his entire weight on the diseased hip-joint, the pain commences; if asked in what particular part of the joint he feels most suffering, he points to the back part of the trochanter and to a point which corresponded to the situation of the lesser trochanter; he says the pain shoots from these points down the front of the thigh to the knee. These pains are sometimes more severe, and sometimes less, without his being able to a[] sign any cause for these alteration and he cannot observe that the state of the weather has any influence on them whatever. As he stands at rest, he throws the weight of his body on the left or unaffected limb while the right leg hangs in front and slightly across the left, and seems to be at least three inches shorter; he leans slightly back and supports himself on two sticks: as he walks the right foot is considerably everted, and when he moves without sticks (which he accomplishes with the greatest difficulty) he places the whole sole of the foot flat upon the ground. He never, however, ventures of his own accord to move without the help of two sticks, by the assistance of which he is enabled to walk quicker while moving along thus, the heel of the affected limb does not quite reach the ground, and the lumbar vertebrae undergo great motion. He cannot under any circumstances flex the thigh on the abdomen, so that when he assumes the sitting posture, he is obliged to place himself forwards on the very edge of the seat, the right thigh remaining in the same line as the axis of the trunk, the leg usually flexed and placed under the chair, or across behind the other, and he finds the utmost difficulty in putting on his stockings and shoes. He has scarcely any motion in the hip-joint. When we view the hip in front, and examine it, we see and can feel a considerable bony fulness, corresponding to the horizontal branch of the pubis: the trochanter major seems placed very high up, and is extraordinarily large as if surrounded with ossific deposits. The thigh is somewhat atrophied, being an inch and a half less in circumference than the other, but the calf of the leg is not reduced, and the muscles seem fir; the apparent shortening of the limb, [] rests on the sound one, arises from the lumbar vertebrae being much curved to the opposite side, and the pelvis being elevated on the affected side, while the real shortening ascertained by accurate measurement amounts only to half an inch. If we place the patient horizontally and attempt to communicate to the hip-joint any movement, as of rotation, flexion, abduction, a well-marked crepitus is elicited, and the range of motion if found to be very limited indeed; a little abduction is admitted; rotation and flexion seem just to a sufficient degree to shew that no anchlyosis exists. The movement give some pain to the patient, but we can press the trochanter firmly so as to direct the head of the bone deep against the fundus of the acetabulum, and we can even strike the heel and sole [of] the foot with violence without [] slightest sensation of pain'. The handwritten note at the bottom on the back reads '[]hronic Rheumatic Arthritis of the Hip joints. See Todds Cyclopaedia. Article: Hip joint. Mr Adams. Vide Robert Smith on Fractures [??]. Chronic Rheumatoid Arthritis'.
description: Numbering/sequence: Original reference number: 1776.
description: Date details: This illustration is undated, approximate dates are given based on dates for the entire collection.