54 



ABNORMAL CONDITIONS OF THE KNEE-JOINT. 



and float about loose in the interior. We have 

 found the minute capillary vessels of the car- 

 tilages faintly traced in red lines, and have also 

 discovered that these vessels admit the colour- 

 ing matter of our injections. The vascularity 

 of the cartilages under the influence of acute 

 inflammation seems to be fully proved. We 

 have it on the authority of Sir B. Brodie that 

 he had been able to detect with the naked eye 

 vessels in articular cartilage filled by blood ; 

 and it is fresh in the recollection of the profes- 

 sion that Mr. Listen has lately laid before the 

 Medico-Chirurgical Society important obser- 

 vations on this subject. The periosteum of 

 the bones in the immediate vicinity of the knee 

 is usually found to be of a red colour, thicker 

 than natural, and easily detached from the 

 bone ; the bones themselves occasionally pre- 

 sent a reddish or pink hue externally, and a 

 section of them shews, by its bright red colour, 

 an increase in the number or size of the capil- 

 lary vessels, admitting red blood, which per- 

 vade their medullary membrane and cancellated 

 structure. 



Example of acute arthritis genu. Michael 

 Roche, twenty-seven years of age, was admitted 

 into the Richmond Hospital in April 1832. He 

 had an emaciated appearance, a dry tongue, 

 and some fever. He complained of severe 

 pain in the left knee, which completely inter- 

 rupted sleep, and of frequent spasmodic start- 

 ings of the limb. The limb was so much 

 swollen that measurement of it showed an in- 

 crease of six inches in its circumference over 

 the sound one. The superficial veins were di- 

 lated, the patella was thrown much forwards, 

 and the leg and foot were cedematous ; the in- 

 teguments were red and thinned, and a fluctu- 

 ation of matter in the joint was very evident. 

 He stated this violent attack to be of five weeks' 

 duration, having commenced with a very severe 

 rigor, and attributed it to his having lain for 

 some hours on wet grass. Three years previ- 

 ously he had had an attack of acute inflamma- 

 tion of the knee, which, however, quickly sub- 

 sided, but leaving a stiffness of the joint. An 

 opening was made with a lancet into the part 

 of the knee-joint which was red and thinned, 

 and eight ounces of purulent matter were let 

 out, but no relief was afforded. Some super- 

 ficial inflammation was observed, in the course 

 of the lymphatics to the groin, from the wound, 

 as also swelling of the inguinal glands. The 

 spasmodic starlings of the limb became more 

 urgent, and the cedema increased. On the 

 17th of April Dr. M'Dowel amputated the 

 limb. The incision passed through a sinus 

 which he thought it necessary to dissect out. 

 The muscles did not retract. On the following 

 day the report from the man was that he rested 

 well at night. But on the fourth day after 

 the operation his countenance was flushed, his 

 pulse feeble 96, and he complained much of 

 the pain of the stump. On the 22d of April, 

 the fifth day after the amputation, he had a 

 rigor followed by a hot and sweating stage : 

 his pulse amounted to 144. For some days 

 subsequently he had frequent rigors. The 

 stump was not doing well; the muscles were 



shrinking away daily and leaving the bone tin- 

 covered. The edges of the wound had a 

 sloughy appearance, and towards the end of 

 the month he was attacked with diarrhoea which 

 in a few days proved fatal. 



On an examination of the knee-joint all the 

 structures entering into its composition exhi- 

 bited evidence of their having been the seat of 

 recent high inflammatory action. The bones 

 and synovial membrane presented a very great 

 degree of vascularity and redness; purulent 

 matter and flakes of lymph were contained in 

 the interior of the joint ; a fragment of one of 

 the semilunar cartilages alone remained, and 

 the articular cartilages were in many places 

 removed altogether; in other situations these 

 latter were thinned very much, and in one or 

 two places a number of minute perforations 

 were seen in the articular cartilage investing 

 the lower end of the outer condyle of the 

 femur. The minute vessels of the joint were 

 rendered evident by a previous injection of 

 fluid size coloured by vermillion. The syno- 

 vial membrane was much thickened and raised 

 above the level of the cartilages ; it presented 

 a red pulpy appearance, and productions from 

 it passed from the side of the femoral condyles 

 and were loosely folded over the articular carti- 

 lages ; and wherever this loose membrane was 

 in contact with the articular cartilages, these 

 seemed to have been absorbed. Depressions 

 in the cartilages exactly corresponded in form 

 with this vascular membrane, which was lodged 

 in these superficial depressions. The articular 

 cartilages were thinned, and when elevated from 

 the bone a red pulpy membrane, very similar in 

 appearance to the free surface which the synovial 

 membrane presented, was seen. The minute 

 pores and perforations in the articular cartilages 

 already noticed were evidently formed by the 

 action of a pulpy membrane subjacent to them, 

 and causing their absorption, evidently in the 

 same manner, it appears to us, as we find an 

 exfoliation from a flat bone of the cranium to 

 be perforated by the absorbing powers of the 

 granulations proceeding from the bone beneath 

 it. In examining this preparation, and reflect- 

 ing on the history of the case, it would appear 

 that when the limb was amputated, the com- 

 plete destruction of the articular cartilage was 

 in progress. On the free surface towards the 

 cavity of the joint, the cartilage was evidently 

 absorbed by the villous productions from the 

 inflamed synovial membrane; on the osseous 

 surface the cartilage was acted upon by a pulpy 

 membrane, which existed here also, and it was 

 this membrane which was produced from the 

 bone and caused the number of minute perfo- 

 rations already alluded to, having partially 

 removed the articular cartilage.* The bones 

 were in a condition of hypersemia. This newly 

 formed membrane seems to be endowed with a 

 power of absorbing, by its villi, the cartilage 

 with which it comes in contact ; for we must 

 agree with Mr. Key that these vascular fimbrise 

 or tufts are often buried into excavations in the 



* The preparation is preserved in the museum 

 of the Richmond Hospital. 



