The circumstances attending the first stage of the disease in childhood, in which the limb is lengthened, and there is no decrease, but rather an enlargement of the parts composing the joint, have been already described and illustrated. When, however, absorption occurs, and the articulation begins to be destroyed, the second stage of the disease commences, and the limb becomes then sensibly shortened; the toes are turned inwards or outwards; in many cases there is every appearance of dislocation of the thigh upward and backward; and in others the limb is much bent, the toes only reaching the ground. The ultimate position of the limb and degree of shortening will depend much upon the extent to which the head and neck of the femur is destroyed, upon the inclination of the pelvis, and also upon the portion of the acetabulum which is most diseased. The joint becomes tender, the slightest motion causing much pain, and the parts around appear swollen. The patient retains the limb in the most comfortable position, and it is generally bent upon the pelvis and inverted. This may arise from relief being afforded when the psoas is relaxed, and the pressure thus removed from the fore part of the joint. In many cases matter forms behind, or rather below, the trochanter major, and the collection often attains a large size. When the presence of matter has been ascertained in this situation, it has been recommended that an early opening should be made, on the supposition that the disease arises from an acrimonious discharge into and round the joint, and that, by the matter being allowed to escape, the cause of the disease may be removed. The synovia has been compared by one old author to bland oil, the vitiated secretion to oil of vitriol. Though the principle is incorrect, still the rule of practice is important; for in consequence of the long-continued presence of matter, accumulating in a cavity which is not dilatable in proportion to the increase of purulent secretion, the original affection will be much aggravated, and disease induced in the neighbouring parts. But the existence of matter in the joint could only be ascertained to exist in a very emaciated person. [Illustration]