Caries from Pus-forming Organisms. 235 



6. 83. Acute Suppurative Intlammation in the Lower 

 Epiphysis of the Femur (Acute Epiphysitis).— Outer 



half of the right knee of a boy aged four — injected, and in 

 spirit, showing the effects of the above. 



J. G. was admitted to Ward 18 on the 12th February 1890. He 

 had a satisfactory family history and good previous health. About 

 the beginning of January he had been suddenly seized with a severe 

 pain in the right knee when asleep, and the leg became firmly flexed. 

 This subsided, but was followed by frequent muscular spasms, producing 

 complete flexion and great pain. These increased in severity, and became 

 worse at night. A swelling then appeared in the region of the knee, and 

 these attacks ceased. 



On admission, he was very weak and thin. The limb was flexed, 

 but could be straightened, and there was considerable swelling in the 

 region of the knee, with pain and tenderness limited to the lower parts 

 of the femur. The knee was treated by extension, afterwards by Scott's 

 dressing and a plaster case. On removing these there were pains on the 

 inner side over the epiphysis, and thickening of the synovial membrane. 

 On the 11th March the painful spot was incised and pus escaped. No 

 bare bone. \Atli March. — The temperature, pain, and swelling were worse, 

 and the wound was " septic. " 20;!/i MarcJi. — Explored and a necrosis of the 

 femur diagnosed. Part of the epiphyseal cartilage was diseased. The 

 joint was opened into and drained. ^^jn7 1. — The patient has been going 

 down-hill, suffering from septicemia, so Mr Cathcart amputated through 

 the thigh. The patient recovered. 



The softening and destruction of the epiphysis and adjacent 

 portion of the shaft is distinct. An abscess had started to 

 burrow up into the popliteal space. G. C. 3179. 



Presented by Charles W. Cathcart, F.R.C.S.E. 



6. 84. Acute Suppurative Inflammation of the Lower 

 End of the Femur, with Erosion and Rarefaction.— 



Lower end of the shaft of a right femur (epiphysis wanting) 

 - — macerated, showing the above. 



"The patient, G. Y., aged 16, stated that, seven weeks ago, 

 while walking, he was tripped, and his knee came in contact with a small 

 stone. This caused no visible injury. He continued walking for two 

 days after, when his knee swelled and became extremely painful. These 

 symptoms, accompanied with much febrile irritation, continued for a 

 month, during which time leeches and cold applications were first em- 

 ployed, and afterwards poultices and fomentations. Three weeks ago an 



