Perhaps the application of Koch's method will, besides curing the disease, give us information regarding the functions of the suprarenal capsules about which nothing whatever is as yet known.
A large space in the realm of disease is claimed by tuberculous affections of the bones and joints. These afflictions appear particularly in childhood though manhood is by no means exempt. They may appear in all portions of the body, although a marked preference is shown for certain parts. Although the tubercle-bacilli are infinitely small, they possess the power to cause suppuration of the bones and joints and to produce acute inflammation of these parts.
Most frequently tubercular affections of the bones are found in the hip-joints, the knee and the spinal column.
Tuberculous inflammation of the hip-joint is principally a disease occurring in childhood; though it rarely appears before the third year. It is most frequent from the fifth to the tenth year.
Inflammation of the hip-joint developes very slowly in children, it generally takes months before the slightest beginning symptoms reach a threatening appearance. The first sign is lameness; among laymen tuberculous inflammation of the hip-joints is known as "voluntary limping."
By limping we understand that mode of walking in which one leg is spared and by this the trunk is supported only a short time by one extremity and all the longer by the other. In every painful affection of the lower extremity limping results as the weight of the body increases the pain. The lameness in the case of diseased hip-joint has something peculiar about it, inasmuch as not only a part of the extremity but the whole of it is dragged. For this very reason parents of children afflicted with inflammation of the hip-joint use the expression "the child draws" or "drags the leg".
In the beginning even the examining physician finds no symptoms of disease in the joint. No swelling, no abnormal position, no restriction of the freedom of motion, no pain from pressure or while moving, in short nothing can be found that would otherwise indicate the beginning of an inflammation of the joints.
Yet lameness only is sufficient data from which we may infer the probable beginning of hip-joint inflammation. It is much better to overestimate the significance of this symptom than to miss the proper time for calling in the aid of a physician by placing too little confidence on it.
The second symptom, pain, rarely attends the beginning of lameness, generally it comes 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.