ABNORMAL CONDITIONS OF THE KNEE-JOINT. 
articulation, and are associated with some form 
of inflammatory action, either acute or chronic. 
Simple acute inflammation of the knee-joint, 
or acute arthritis genu, may be the result of a 
contusion, a sprain, or a wound; or there may 
be no assignable cause. In the latter case it 
may have been preceded by rheumatic fever, 
_ erysipelas, or diffuse inflammation, which had 
| previously engaged distant organs and other 
_ Structures. The symptoms are usually strongly 
marked. Considerable pain, which comes on 
_ very suddenly, is felt in the knee; the leg in 
_ Most cases soon becomes flexed and reposes on 
its outside; and the patient cannot bear the 
_ slightest movement to be communicated to the 
_knee-joint. There is considerable increase of 
_ temperature in the skin over the affected arti- 
 Culation, together with tension of it from in- 
_ Ordinate effusion of synovial fluid into the 
joint. Although the usual phenomena of red- 
ness as anaccompaniment of phlogosis may not 
be observed externally, there can be but little 
doubt that the capillary vessels pervading the 
different structures of the interior of the joint 
are in a state of hyperemia. The patient'has 
but little sleep, and this is frequently inter- 
rupted by unpleasant dreams and painful spas- 
_ modic startings of the affected extremity. Cde- 
ma of the lower part of the limb now occurs, 
_ and in severe cases sometimes extends up the 
whole leg and thigh, even to the groin. The 
, Para refnetio fever may run so high, and the 
swelling and other local symptoms proceed so 
_ rapidly as to deprive the surgeon of any oppor- 
tunity of proposing or performing amputation 
_ to save the patient’s life. 
_ The fever in well-marked cases of acute ar- 
_thritis genu is sometimes symptomatic of the 
local disease ; sometimes it has preceded the 
“local affection, and has been ushered in bya 
_ very severe rigour followed by profuse perspi- 
‘tation. Like the disease, the fever will vary in 
its character. Erysipelas, rheumatic fever, and 
diffuse inflammation, as has been mentioned, 
will each occasionally present in their progress 
‘pnt of the disease of the knee-joint now 
under consideration, and the accompanying 
fever will bear the character of the disease with 
which the inflammatory affection of the joint is 
“associated. The local phenomena presented 
by an acute arthritis genu do not, however, 
Vary so much, except in degree and severity. 
_ Acute arthritis genu may supervene as 
4 consequence of wounds. Sometimes these 
wounds are very small. We have known one 
“tase in which a puncture made with a fine sew- 
ig needle, which was accidentally driven with 
force into the knee-joint, at the inside of the 
‘patella, was the cause of a fatal inflammation 
‘of the joint: the point of the needle probably 
penetrated the bone. The patient, a young 
‘Woman, was under the care of Mr. Colles 
Many years ago, in Steevens’s Hospital. In 
Some instances we have known inflammation of 
the synovial membrane of the knee to have 
been the result of a wound of the subcrureal 
bursa. A countryman had received a trans- 
verse wound by the cut of a broadsword 
just above the patella, and fatal inflammation 
VOL. III. 
49 
extended from this bursa, which was opened, to 
the synovial sac of the knee-joint. 
Acute inflammation of the knee-joint has 
been the result of surgical operations, such, for 
instance, as that occasionally undertaken for the 
extraction of moveable bodies which form in 
the joint and interfere with the due perform- 
ance of its functions. This operation, we be- 
lieve, is now very seldom recommended. We 
have heard and read of many cases in which 
it has been performed with complete success ; 
on the other hand, we have reason to know 
that many have died of the inflammation con- 
sequent on it, and that others have narrowly 
cacaped with their lives, having ever after- 
wards an anchylosed knee-joint. It is rather 
singular, but we believe it to be true, that 
the inflammation resulting from a valvular 
opening having been made in the knee-joint 
has not come on for six or seven days after the 
moveable cartilage has been extracted ; bat in- 
flammation being once set up, its course is ge- 
nerally acute and dangerous. 
We consider the observations and experience 
of Mr. Guthrie on the subject of wounds of 
the knee-joint to be too valuable to be here 
passed over. ‘ Wounds of the knee-joint,” he 
remarks, “ however simple, should always be 
considered of a dangerous nature, infinitely 
more so than of the shoulder, the elbow, or the 
ankle.” ‘TI could,” he adds, “ relate an infi- 
nite number of cases on these points, termi- 
nating fatally or in amputation, where the in- 
jury was severe, or apparently at first but slight, 
and but few cases where the capsular ligament 
was opened ‘into by a musket-ball, where the 
patient has preserved the use of the limb. In 
every case where the wound was known to be 
serious, I have invariably been disappointed in 
the hope of saving the limb.” He then adduces 
the following case as an instance of apparent 
simple injury that frequently occurs. “ This 
case,” he adds, “ will shew the danger of all 
these wounds, and the very great care and at- 
tention that are necessary for their cure. Co- 
lonel Donellan, of the forty-eighth regiment, 
was wounded at the battle of Talavera in the 
knee-joint by a musket-ball, which gave him so 
little uneasiness, that when a roller had been 
put on his leg, with some simple dressing, he 
could scarcely be persuaded to proceed to the 
rear. Ata little distance from the fire of the 
enemy we talked over the affairs of the mo- 
ment, when, tossing his leg about on the 
saddle, he declared he felt no inconvenience 
from the wound, and would go back, as he saw 
his corps was very much exposed. I explained 
to him the dangerous nature of the wounds of 
the knee-joint, and after he had staid with me 
a couple of hours, I persuaded him to go into 
the town. This injury, although at first to all 
appearance so trifling, and under the best sur- 
gical care, caused the death of this officer in a 
very short time, and proceeded so rapidly as to 
prevent any relief at last being obtained by 
amputation.” 
Some years ago MM. Larrey and Garriques, 
in France, recommended the amputation of the 
leg immediately below the tuberosity of the 
E 
