52 
of the cartilages by subsynovial infiltration. 
The ligamentum mucosum, as it is called, was 
very vascular. The capillary system of the 
semilunar cartilages was injected with minute 
red vessels. The left knee-joint, which had 
been but lately attacked, contained an inordinate 
quantity of synovial fluid, of a greenish-yellow 
hue, and of a thicker consistence and a deeper 
colour than natural. The synovial membrane 
was pale, and there was no infiltration in its 
subsynovial structure. The vein in which 
venesection had been performed was contracted 
in the neighbourhood of the wound, and lymph 
adhered to its lining membrane. Above the 
right elbow-joint and internal to the course of 
the vein, there was a small collection of matter 
between the skin and fascia. 
Susan Brett, et. 24, was brought into the 
Richmond hospital on 26th February in great 
distress and pain. On the 14th February she 
was suddenly seized with convulsions, being 
seven months pregnant. She was bled in the 
right arm and her head shaved. Two days 
after the operation the arm became very painful 
and swollen. The pain increased, and on the 
2ist labour-pains came on and continued 
during the day. In the evening she was again 
attacked with convulsions, and blood was 
drawn from the left arm. The child (her first) 
was not expelled until early the next morn- 
ing; the evening of the same day she had a 
severe rigour, which lasted half an hour, and 
was succeeded by profuse perspiration; this 
soon went off, but she remained cold and 
chilly for the remainder of the night. On the 
following morning (23d) she was seized with 
what she called severe rheumatic pains in her 
hips and right shoulder, which left her “all 
sore” and completely powerless. On the 24th 
the pain in the right shoulder-joint became 
most intense, and a severe stitch seized her in 
the same side, which prevented her drawing 
her breath. The pain in the arm also was now 
very severe, extending upwards from where ve- 
nesection was originally ier: The wound 
was found not yet healed. 
When brought to the hospital, the fifth day 
from her lying-in, she was in great distress and 
ain. Her pulse was 140, with some fulness, 
ut still compressible. She preferred lying on 
her right side bent forwards, with her knees 
drawn up- Her respirations were fifty-two in a 
minute, and greatly oppressed. At each effort 
of inspiration the ale nasi were much dilated. 
Her countenance was anxious, and there was a 
bright circumscribed flush on each malar emi- 
nence. For the last week she has raved con- 
stantly at night, and has been more ill at cer- 
tain hours of the day, very early in the morn- 
ing, and again at half-past five, p.m. At the . 
latter hour she was generally found perspiring 
copiously. Her bowels were too free. She 
complained of pain chiefly in the right shoulder 
and the lower part of the back; also in both 
her knees and metacarpal joint of the index- 
finger of the left hand. She also complained 
of her left hip. The right arm was swollen 
but not discoloured, «dematous, and pitting on 
pressure. The original wound made for vene- 
ABNORMAL CONDITIONS OF THE KNEE-JOINT. 
section was ing, with unhealthy everted 
edges ; no ise coddel from it. She kept 
the arm in the flexed position ; to herself it fel 
quite powerless, and when the least movemer 
was communicated to it, she suffered great tor 
ment. There was a hard line up the arm 
responding to the course of the basilic ve 
and when even the slightest pressure was 1 
in this line, she suffered pain. Immediate 
above the elbow-joint the skin was hard 5 
subcutaneous cellular structure seemed more 
less edematous as if infiltrated with fluid ; 1 
skin and subjacent seemed to be matte 
together and somewhat edematous, and 
sure here also gave the patient much uneasine 
There was a suffused pink blush on the 8 
covering the metacarpal joint of the indi 
finger; the joint was much swollen, and sl 
complained of much pain in it. Her p 
pal suffering was from dyspnea. An exat 
nation of the chest by auscultation and pe 
sion furnished all the evidence of extrem 
bronchitis in both lungs, pleuritis with ine 
pient pneumonia: it was also inferred th 
effusion had taken place into the right side 
the thorax. q 
On the 28th February brs nol those decei 
ful appearances of amendment unusu 
the anikas of acute disease discovered th 
selves. It was reported that she had p 
better night ; her pulse fell to 1285 her res 
ration was reduced to forty in the minute; 
in the evening a pain, which she referred 
the situation of the diaphragm, came on” 
great severity. Her cough was trouble 
and in paroxysms ; she expressed great 
about herself, inquiring whether _were an 
hopes for her, and complained of pain in hi 
left elbow, where, however, there was 
swelling. The original wound made in” 
right arm for the first venesection was : 
open, but there was no inflammation about 
e wounds made in the left arm for two 
sequent bleedings healed perfectly. She no 
had pain in all her joints, Laren h 
metacarpal joint of the index finger 
hand. e shoulder-joints were 
she could not bear the slightest movement: 
them. Her knees were very 1, ch 
the left, which was greatly swollen, but its1 
teguments were not discoloured. Diarrh 
was very troublesome. . 
On the 2d of March profuse perspiratic 
broke out over the whole body, and cx 
of the feet came on. The next morning” 
pulse was 128; respiration was jerking a 
very much hurried ; and her countenance DB 
trayed great internal distress. She had rav 
all night. There was complete orthopneea, ai 
the swelling of the knees increased. She | 
at four o'clock. — 
On an examination of the body twenty-t 
hours after death, the shoulder-joints we 
found to contain a viscid greenish impe 
formed pus. Matter of the same appearance 
but less viscid, was met with on cutting dow 
to the right shoulder-joint among the musel 
external to it. The cartilages in both the 
articulations had lost their colour and seeme 
nx) 
cs 
ie 
