442 Diseases of Joints. 



George Ballingall, delivered to tlie Students of Surgery in the 

 Eoyal Infirmary, Edinburgh, at the conclusion of the winter 

 course for 1828-1829. 



"This poor girl," Helen Coghill, " was admitted on 8th October, 

 and the following report entered in the Journal : 'The left knee is swelled, 

 hot and painful ; the patella is movable, but the slightest movement or 

 pressure upon the bone is attended with very severe pain in the condyles 

 of the femur. The limb is kept constantly in the extended posture. 

 Pulse natural, tongue clean, belly regular. States that her knee was first 

 inflamed ten years ago in consequence of a fall, from the efi'ects of which 

 she never altogether recovered. Eighteen months ago, after a similar 

 accident, the inflammation was much aggravated, and has been more 

 severe than ever during the last seven weeks. Applic. Herud. xx. genv,. ' 



" Subsequent to this various remedies were employed, but without 

 any very obvious or permanent relief, and on the 3rd November I find 

 the following report entered in the Journal : — 



" ' Took three grains of opium and slept a little ; pulse 124 ; tongue 

 slightly furred ; no sweating ; bowels regular ; appetite rather worse. 

 Previous to her admission she had been cupped, and leeches had been 

 applied with benefit. Since her admission she had been leeched three 

 times, and cupped three times to a large amount, and has also had a 

 blister applied, but the disease has certainly become worse.' 



" Leeches were again applied, and were followed at a short interval 

 by the use of the moxus on either side of the patella ; but none of the 

 remedies seemed to check the progress of the disease. The pain was so 

 exquisite, upon any attempt to move the limb, as to preclude any satis- 

 factory examination of the joint. Her appetite failed ; she was occasionally 

 distressed with nausea and retching, and her bowels became greatly 

 disordered. In short, her suff"erings were so severe as to induce her to 

 seek relief by the removal of the limb ; but when this was seriously 

 proposed to her, she requested permission to consult her friends on the 

 subject ; and it was not until the 5th of December that she made up her 

 mind to the operation, which was immediately performed. She seemed 

 relieved, even before the operation was completed. She took seventy 

 drops of laudanum, and slept a little on the following night. She left the 

 Hospital on the 3rd of January. 



"On laying open the joint, after the amputation of the limb, the 

 disease in this poor girl's knee was found to have made very extensive 

 ravages. The preparation, wliich I now again exhibit to you, shows that 

 the cartilages covering all the bones of the joint, with the exception of th;^t 

 on the inner condyle of the femur, were either entirely destroyed or 

 floating loose, being completely detached from the bones. " 



In most places the articular surfaces are covered by granu- 

 lations, now blanched and shrivelled by spirit, but detached 

 pieces of cartilage are seen here and there, and on the inner- 



