Tuhcrcular Synovitis of Knee-joint. 439 



7. 33, Tubercular Synovitis, involving the Cartilag-es and 

 the Bone. — Right knee-joint of a young person, laid open — 

 in spirit, illustrating the above. 



The trochlear surface of the femur and the corresponding 

 surface of the patella are occupied by a mass of new tissue — 

 probably blanched fibrous and granulation tissue — which has 

 extended down into the bone. The rest of the articular 

 surfaces are altered, but to a much less extent. The following 

 is Sir Charles Bell's note, viz., "Specimen of disease of the 

 synovial membrane, from a patient of Mr Brodie's. This is 

 the state of the joint in which I pass the Seton." 



B. C. II. M. 15. 



7. 34. Tubercular Synovitis, involving* the Cartilagre and 

 Bone. — Cast — in gelatine and glycerine — rof the articular 

 surfaces of a knee-joint, laid open, after amputation, for the 

 above. 



David H., aged 42, at the age of 16, was attacked with excessive 

 vomiting and sickness, followed by pain and swelling of the knee. This 

 ended in an abscess near the knee, which was opened. It closed and 

 re-opened, when it discharged some pieces of bone. This opening and 

 closing went on for about fourteen years, when a large piece of bone was 

 removed, probably from the tibia. He then remained apparently well for 

 about twelve years. Two and a half months ago he had pains in his leg, 

 which were considered rheumatic. This was followed by swelling of the 

 knee, and he was admitted to the Koyal Infirmary. An abscess over the 

 near condyle of the femur was opened but soon turned septic, and other 

 abscesses formed round about and burrowed in the calf of the leg. As 

 his constitution was suffering and his knee getting worse, the leg was 

 amputated. 



The cast shows that the articular cartilage is left only at 

 one place, viz., on the outer half of the trochlear surface. The 

 greater part of the rest is covered by vascular granulations, but 

 upon the inner condyle are seen two patches of what was bare, 

 smooth, necrotic bone. The articular surface of the tibia is 

 covered by vascular granulations. 



The cicatrix of the former abscess is seen round the head 

 of the tibia. 



