ABNORMAL CONDITIONS OF THE KNEE-JOINT. 
thinner than. natural, but were not ulcerated. 
e elbow-joints were in a normal condition. 
‘The joint of the index finger contained a thin 
greyish coloured matter, which was not con- 
fined to the joint, being also found in the mus- 
cles external to it. The cartilages on the head 
of the metacarpal bone and corresponding sur- 
face of the index finger were much ulcerated 
and partially removed. The knee-joints con- ’ 
tained a 
large quantity of a viscid greenish 
matter like lime-water and oil. Behind the 
right knee-joint, and extending down to the 
gastrocnemii muscles, matter of somewhat a 
similar character, except that no synovial fluid 
was mixed with it, occupied the interstices of 
the muscles and the cellular tissue of the lower 
- of the popliteal region. The hip-joint 
did not contain any matter. 
The basilic vein of the right arm was plugged 
up with a dense coagulum, which closely ad- 
hered to its internal tunic, and was not easily 
separable from it. There was no pus in the 
a 3 its exterior presented an unusual red co- 
our. 
On opening the cavity of the chest a quan- 
tity of serum escaped. There was a great 
quantity of a very yellow lymph effused on the 
surface of the pleura of both lungs, principally 
the right. In many places it was very thick, 
rough, and consistent. On the diaphragm and 
in the right side of the chest the lymph was 
soft, of a greenish colour, being in shreds 
easily removed, and leaving the subjacent mem- 
brane highly vascular. There were also evi- 
dences of interlobular pleuritis having existed : 
all division into lobes had been effaced. The 
lungs presented specimens of pneumonia in its 
three stages. A very small portion of the apex 
of the left lung alone seemed healthy, but 
even here the bronchial membrane was en- 
gaged and presented evidences of bronchitis 
having existed. In the substance of the lungs 
_ there were also found small abscesses present- 
_ing near their surface like little gangrenous 
_ abscesses surrounded by ecchymosed red spots ; 
_ these contained some grumous dark-coloured 
_ fluid, which, however, was inodorous. In others 
_ was found an ill-digested purulent matter ; and 
_ leading to one of these disorganized portions 
of the right lung near its apex, the minute 
veins on very careful dissection were found 
_ thickened, with yellow parietes; and many of 
_ those present at the examination satisfied them- 
_ Selves that these minute veins contained puru- 
lent matter. The heart and pericardium were 
natural. The most careful examination could 
_ discover nothing abnormal in the uterus. The 
_ large intestines throughout presented numerous 
RB slcerations on their mucous surface ; the neigh- 
_ bourhood of the ileo-ccecal valve being most 
_ beset by them. The mucous membrane was in 
_ astate of hyperemia. 
prognosis in cases of acute arthritis genu 
isin general very unfavourable except when the 
disease accompanies what has been usually 
termed rheumatic fever. In this case the syno- 
vial system of all the articulations is visited in 
succession, until the inflammatory disease ex- 
hausts itself as it were in three or four weeks, 
53 
often leaving no trace behind. It is, however, 
well known to medical men that in the course 
of these fevers fatal metastasis may occur from 
the synovial membrane of the knee or other 
joint to the pericardium or peritoneum.* In 
some few cases, after the general rheumatic 
fever and acute specific arthritis had subsided, 
we have known the chronic rheumatism, or 
nodosity of the joints, to set in, remaining 
permanently to interrupt the patient’s health. 
Not long ago there was a young woman in the 
Richmond Hospital, under the care of Dr. 
Hutton, having acute arthritis of the right 
knee-joint, which had remained after a severe 
attack ofsgeneral rheumatic fever. All the 
joints in succession had been visited by in- 
flammation. The fever, with its debilitating 
accompaniments, profuse perspirations, &c. 
subsided, but the local symptoms of acute 
arthritis of the right knee-joint continued, and 
increased even to suppuration, nor did ampu- 
tation of the limb save the patient’s life. These 
unfavourable results of acute arthritis, of the 
rheumatic form, may be considered as excep- 
tions. In general the form of inflammation of 
the joints, commonly called rheumatic fever, 
terminates favourably ; on the contrary, in cases 
where the knee-joints and other articulations 
are engaged during an attack of diffuse inflam- 
mation, puerperal arthritis, or phlebitis, the 
prognosis is most unfavourable, the disease in 
all these cases being generally fatal whether 
the joints be implicated or not. 
Anatomical characters of the acute arthritis 
of the knee——On examining the interior of a 
knee-joint which had recently been the seat of 
acute inflammation, we find that the synovial 
fluid has accumulated in the cavity of the 
joint, and that it is mixed with purulent 
matter; when this is removed, we perceive 
that the synovial sac has been widened and 
enlarged, and that the subsynovial tissue is 
much infiltrated, causing the synovial mem- 
brane to be raised up above the level of the 
articular cartilages. We have seen the syno- 
vial membrane or subsynovial tissue as red as 
the conjunctiva eculi in acute purulent ophthal- 
mia. In these cases the articular cartilages 
lose much of their natural white silvery lustre, 
become yellowish, and are found softened at 
their edges or circumference, where the ele- 
vated and inflamed synovial membrane is in 
contact with them. We have found the carti- 
lage of the patella softened and partially de- 
tached from the bone, even in very recent 
cases. In cutting down to the joint we have 
noticed an alteration in the natural colour of 
the muscles ; and outside the synovial sac we 
often encounter abscesses containing true pus. 
Generally speaking this sac is of an intensely 
red colour, and covered here and there with a 
green but not very consistent layer of organi- 
zable lymph. Some fragments of thinned 
shreds of exfoliated articular cartilage, with 
serrated edges, hang into the cavity of the 
joint, and some portions are altogether free, 
* See Dublin Hosp. Rep. vol. ii. p. 321. vol. iv. 
p- 368. © ; 
