Tubercular Synovitis of Knee-joint. 437 



may burst at once into the joint, and rapidly disseminate the 

 disease, or burrow away from the joint, burst externally at a 

 variable distance from it, and only after some time, if at all, 

 communicate with its interior. B. C. ii. M. 16. 



7. 29. Tubercular Synovitis of Knee-Joint, with Destruc- 

 tion of the Articular Surfaces. — Cast in gelatine and 

 glycerine of the front of a left knee which was in the above 

 condition. 



The patient, Mary W. , aged 25, had complained first of her knee, six 

 years before. She was then a field worker. Under rest and blistering 

 the symptoms subsided, but reappeared when work was renewed. This 

 occurred several times, the longest interval of health being for a year in 

 1884, and again in 1886. In December 1887 pain and swelling became 

 much worse. A Thomas splint then tried was found of no use, and in 

 April 1888 slie came to Dr John Duncan's wards with the knee in the 

 condition indicated by the cast. A pufi'y swelling was present also at 

 the outer part of the ankle-joint. This, together with the patient's wish, 

 determined Dr Duncan to amputate rather than to excise. 



The cast shows the uniform globular swelling of the joint 

 characteristic of tubercular synovitis. G. C. 2789. 



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



7. 30. Tubercular Synovitis of the Knee-Joint, with 

 Destruction of the Articular Surfaces.— Cast in gelatine 



and glycerine of the same knee, laid open after amputation. 



The patella is thrown down over the tibia. There had 

 been recent suppuration within the joint. The only portions 

 of articular cartilage remaining are seen on the outer condyle and 

 the outer half of the trochlea of the femur. The rest of the 

 articular cartilage is replaced partly by recent granulations, 

 indicated by the strong colour, partly by fully formed fibrous 

 tissue, which covers the articular surface of the patella and 

 the upper part of the trochlear surface of the femur. A plug of 

 fat occupies the inter-condyloid notch ; over the surface of the 



