ABNORMAL CONDITIONS OF THE KNEE-JOINT. 



53 



thinner than natural, but were not ulcerated. 

 The elbow-joints were in a normal condition. 

 The joint of the index finger contained a thin 

 greyish coloured matter, which was not con- 

 fined to the joint, being also found in the mus- 

 cles external to it. The cartilages on the head 

 of the metacarpal bone and corresponding sur- 

 face of the index finger were much ulcerated 

 and partially removed. The knee-joints con- 

 tained a large quantity of a viscid greenish 

 matter like lime-water and oil. Behind the 

 right knee-joint, and extending down to the 

 gastrocnemii muscles, matter of somewhat a 

 similar character, except that no synovial fluid 

 was mixed with it, occupied the interstices of 

 the muscles and the cellular tissue of the lower 

 part of the poplitccal region. The hip-joint 

 did not contain any matter. 



The basilic vein of the right arm was plugged 

 up with a dense coagulum, which closely ad- 

 hered to its internal tunic, and was not easily 

 separable from it. There was no pus in the 

 vein ; its exterior presented an unusual red co- 

 lour. 



On opening the cavity of the chest a quan- 

 tity of serum escaped. There was a great 

 quantity of a very yellow lymph effused on the 

 surface of the pleura of both lungs, principally 

 the right. In many places it was very thick, 

 rough, and consistent. On the diaphragm and 

 in the right side of the chest the lymph was 

 soft, of a greenish colour, being in shreds 

 easily removed, and leaving the subjacent mem- 

 brane highly vascular. There were also evi- 

 dences of interlobular pleuritis having existed : 

 all division into lobes had been effaced. The 

 lungs presented specimens of pneumonia in its 

 three stages. A very small portion of the apex 

 of the left lung alone seemed healthy, but 

 even here the bronchial membrane was en- 

 gaged and presented evidences of bronchitis 

 having existed. In the substance of the lungs 

 there were also found small abscesses present- 

 ing near their surface like little gangrenous 

 abscesses surrounded by ecchymosed red spots ; 

 these contained some grumous dark-coloured 

 fluid, which, however, was inodorous. In others 

 was found an ill-digested purulent matter ; and 

 leading to one of these disorganized portions 

 of the right lung near its apex, the minute 

 veins on very careful dissection were found 

 thickened, with yellow parietes; and many of 

 those present at the examination satisfied them- 

 selves that these minute veins contained puru- 

 lent matter. The heart and pericardium were 

 natural. The most careful examination could 

 discover nothing abnormal in the uterus. The 

 large intestines throughout presented numerous 

 ulcerations on their mucous surface ; the neigh- 

 bourhood of the ileo-ccecal valve being most 

 beset by them. The mucous membrane was in 

 a state of hyperamia. 



The prognosis in cases of acute arthritis genu 

 is in general very unfavourable except when the 

 disease accompanies what has been usually 

 termed rheumatic fever. In this case the syno- 

 vial system of all the articulations is visited in 

 succession, until the inflammatory disease ex- 

 hausts itself as it were in three or four weeks, 



often leaving no trace behind. It is, however, 

 well known to medical men that in the course 

 of these fevers fatal metastasis may occur from 

 the synovial membrane of the knee or other 

 joint to the pericardium or peritoneum.* In 

 some few cases, after the general rheumatic 

 fever and acute specific arthritis had subsided, 

 we have known the chronic rheumatism, or 

 nodosity of the joints, to set in, remaining 

 permanently to interrupt the patient's health. 

 Not long ago there was a young woman in the 

 Richmond Hospital, under the care of Dr. 

 Ilutton, having acute arthritis of the right 

 knee-joint, which had remained after a severe 

 attack of general rheumatic fever. All the 

 joints in succession had been visited by in- 

 flammation. The fever, with its debilitating 

 accompaniments, profuse perspirations, &c. 

 subsided, but the local symptoms of acute 

 arthritis of the right knee-joint continued, and 

 increased even to suppuration, nor did ampu- 

 tation of the limb save the patient's life. These 

 unfavourable results of acute arthritis, of the 

 rheumatic form, may be considered as excep- 

 tions. In general the form of inflammation of 

 the joints, commonly called rheumatic fever, 

 terminates favourably ; on the contrary, in cases 

 where the knee-joints and other articulations 

 are engaged during an attack of diffuse inflam- 

 mation, puerperal arthritis, or phlebitis, the 

 prognosis is most unfavourable, the disease in 

 all these cases being generally fatal whether 

 the joints be implicated or not. 



Anatomical characters of the acute arthritis 

 of the knee. On examining the interior of a 

 knee-joint which had recently been the seat of 

 acute inflammation, we find that the synovial 

 fluid has accumulated in the cavity of the 

 joint, and that it is mixed with purulent 

 matter; when this is removed, we perceive 

 that the synovial sac has been widened and 

 enlarged, and that the subsynovial tissue is 

 much infiltrated, causing the synovial mem- 

 brane to be raised up above the level of the 

 articular cartilages. We have seen the syno- 

 vial membrane or subsynovial tissue as red as 

 the conjunctiva oculi in acute purulent ophthal- 

 mia. In these cases the articular cartilages 

 lose much of their natural white silvery lustre, 

 become yellowish, and are found softened at 

 their edges or circumference, where the ele- 

 vated and inflamed synovial membrane is in 

 contact with them. VVe have found the carti- 

 lage of the patella softened and partially de- 

 tached from the bone, even in very recent 

 cases. In cutting down to the joint we have 

 noticed an. alteration in the natural colour of 

 the muscles ; and outside the synovial sac we 

 often encounter abscesses containing true pus. 

 Generally speaking this sac is of an intensely 

 red colour, and covered here and there with a 

 green but not very consistent layer of organ i- 

 zqble lymph. Some fragments of thinned 

 shreds of exfoliated articular cartilage, with 

 serrated edges, hang into the cavity of the 

 joint, and some portions are altogether free, 



* See Dublin Hosp. Rep. vol. ii. p. 321. vol. iv. 

 p. 365. 



