455 Diseases of Joints. 



Necrosis in the Head of the Tibia. — Bones of the right 



knee-joint of an adult, separated from behind to expose the 

 articular surfaces from the back — in spirit. 



The joint was from a patient in the Royal Infirmary, 50 years 

 of age, who recovered after amputation of the limb. He had fallen into 

 the hold of a ship 38 years previously, by which he received a severe 

 injury of the knee — swelling, pain, stiffness, and abscesses about the joint 

 followed. These abated, but left the joint quite stiff and bent at a right 

 angle. Four months before he came to the hospital, abscesses again 

 formed, attended with considerable constitutional disturbance. One of 

 these left an external opening into the joint. 



The joint has evidently been flexed, and the patella is 

 anchylosed to the under surface of the outer condyle. The 

 posterior part of the outer condyle is wanting, and the place of 

 the bone in the neighbourhood is taken by fibrous tissue. The 

 articular surfaces on the back of the inner condyle and the 

 inner tuberosity of the tibia are comparatively unchanged, but 

 the articular surface of the outer tuberosity of the tibia is 

 represented partly by a large necrosed fragment, and partly by 

 fibrous tissue. G. C. 2230. 



Presented hy Alkxaxdeu Watsox, F.R.C.S.E., 1836. 



7. 78. Tubercular Arthritis breaking- out after Sub- 

 sidence. — Inner section of the bones forming the right knee- 

 joint of a woman — in spirit, showing the fatty and absorbed 

 state of the bone, and altered articular surface. 



Emma M., 9 years before operation, fell and hurt her Ivnee, which 

 bet-ame swollen, but otherwise did not trouble her for 8 years. Last 

 year it caused her some inconvenience, and having fomented it without 

 effect, she was admitted to Ward 14, and remained there for about seven 

 weeks. Her leg was first put in splints, then blistered, and afterwards 

 extension was applied, the knee, liowever, getting worse all the time. 

 She then went home, and painted it with iodine, without much improve- 

 ment. "When admitted to AVard 17, the knee was painful, and greatly 

 swollen, especially on the inner side. Three days after admission the 

 leg was amputated, and she made a good recovery. 



The tibia has been partly dislocated backwards from the 

 femur. Fibrous tissue has formed above the patella, and at 



