hich is the
most reliable sign of hip disease during the initial stage, and they
possess the advantage of being universally applicable, even in the
case of young children.

_Second Stage._--This probably corresponds with commencing disease of
the articular surfaces, and progressive involvement of all the
structures of the joint. The child complains more, and usually
exhibits the attitude of abduction, eversion, and flexion (Fig. 109).

[Illustration: FIG. 109.--Early Tuberculous Disease of Right Hip-joint
in a boy aet. 14, showing flexion, abduction, and apparent lengthening
of the limb.]

At first the attitude is maintained entirely by the action of muscles;
but when it is prolonged, the muscles, fasciae, and ligaments undergo
shortening, so that it becomes fixed.

On looking at the patient, the abnormal attitude may not be at once
evident, as he usually restores the parallelism of the limbs by
lowering the pelvis on the affected side and adducting the sound limb.
This obliquity or tilting of the pelvis causes _apparent lengthening_
of the diseased limb, and is best demonstrated by drawing one straight
line between the anterior iliac spines, and another to meet it from
the xiphoid cartilage through the umbilicus; if the pelvis is in its
normal position, the two lines intersect at right angles; if it is
tilted, the angles at the point of intersection are unequal. The
flexion may be largely compensated for by increasing the forward curve
of the lumbar spine (lordosis), and by flexing the leg at the knee.
There may also be an attempt to compensate for the eversion of the
limb by rotating the pelvis forwards on the affected side.

[Illustration: FIG. 110.--Disease of Left Hip: position of ease
assumed by patient, showing moderate flexion and lordosis.]

[Illustration: FIG. 111.--Disease of Left Hip: disappearance of
lordosis on further flexion of the hip.]

To demonstrate the lordosis, the patient should be laid on a flat
table; in the resting position the lordosis is moderate, when the hip
is flexed it disappears, when it is extended the lordosis is
exaggerated, and the hand or closed fist may be inserted between the
spine and the table (Fig. 112).

[Illustration: FIG. 112.--Disease of Left Hip: exaggeration of
lordosis produced by extending the limb.]

When the functions of the joint are tested, it will be found that
there is rigidity, and that both active and passive movements take
place at the lumbo-sacral