54 
and float about loose in the interior. We have 
found the minute capillary vessels of the car- 
tilages faintly traced in red lines, and have also 
discovered that these vessels admit the colour- 
ing matter of our injections. The vascularity 
of the cartilages under the influence of acute 
inflammation seems to be fully proved. We 
have it on the authority of Sir B. Brodie that 
he had been able to detect with the naked eye 
vessels in articular cartilage filled by blood ; 
and it is fresh in the recollection of the profes- 
sion that Mr. Liston has lately laid before the 
Medico-Chirurgical Society important obser- 
vations on this subject——The periosteum of 
the bones in the immediate vicinity of the knee 
is usually found to be of a red colour, thicker 
than natural, and easily detached from the 
bone ; the bones themselves occasionally pre- 
sent a reddish or pink hue externally, and a 
section of them shews, by its bright red colour, 
an increase in the number or size of the capil- 
— vessels, admitting red blood, which per- 
vade their medullary membrane and cancellated 
structure. 
Example of acute arthritis genu.—Michael 
Roche, twenty-seven years of age, was admitted 
into the Richmond Hospital in April 1832. He 
had an emaciated appearance, a dry tongue, 
and some fever. He complained of severe 
pain in the left knee, which completely inter- 
rupted sleep, and of frequent spasmodic start- 
ings of the limb. The limb was so much 
swollen that measurement of it showed an in- 
crease of six inches in its circumference over 
the sound one. The superficial veins were di- 
lated, the patella was thrown much forwards, 
and the leg and foot were cedematous ; the in- 
teguments were red and thinned, and a fluctu- 
ation of matter in the joint was very evident. 
He stated this violent attack to be of five weeks’ 
duration, having commenced with a very severe 
rigor, and attributed it to his having lain for 
some hours on wet grass. Three years previ- 
ously he had had an attack of acute inflamma- 
tion of the knee, which, however, quickly sub- 
sided, but leaving a stiffness of the joint. An 
opening was made with a lancet into the part 
of the knee-joint which was red and thinned, 
and eight ounces of purulent matter were let 
out, but no relief was afforded. Some super- 
ficial inflammation was observed, in the course 
of the lymphatics to the groin, from the wound, 
as also swelling of the inguinal glands. The 
spasmodic startings of the limb became more 
urgent, and the cdema increased. On the 
17th of April Dr. M‘Dowel amputated the 
limb. The incision passed through a sinus 
which he thought it necessary to dissect out. 
The muscles did not retract. On the following 
day the report from the man was that he rested 
well at night. But on the fourth day after 
the operation his countenance was flushed, his 
pulse feeble—96, and he complained much of 
the pain of the stump. On the 22d of April, 
the fifth day after the amputation, he had a 
rigor followed by a hot and sweating stage: 
his pulse amounted to 144. For some days 
‘subsequently he had frequent rigors. The 
stump was not doing well; the muscles were 
ABNORMAL CONDITIONS OF THE KNEE-JOINT. 
of the Richmond Hospital. 
shrinking away daily and leaving the bone un 
covered. The edges of the wound had a 
sloughy appearance, and towards the end of 
the month he was attacked with diarrhea whie 
in a few days proved fatal. “a 
On an examination of the knee-joint all th 
structures entering into its composition exhi 
bited evidence of their having been the seat o 
recent high inflammatory action. The bon 
and synovial membrane presented a very gre 
degree of vascularity and redness; puruler 
matter and flakes of lymph were contained i 
the interior of the joint; a fragment of one: 
the semilunar cartilages alone remained, am 
the articular cartilages were in many place 
removed altogether; in other situations thes 
latter were thinned very much, and in one ¢ 
two places a number of minute perforation 
were seen in the articular cartilage investir 
the lower end of the outer condyle of the 
femur. The minute vessels of the joint wer 
rendered evident by a previous i on 0 
fluid size coloured by vermillion. yno 
vial membrane was much thickened and raise 
above the level of the ert it presente 
a red pulpy appearance, and uctions fron 
it piano eben te side of the femoral condyle 
and were loosely folded over the articular car 
lages ; and wherever this loose membrane wa 
in contact with the articular cartilages, these 
seemed to have been absorbed. Depressio 
in the cartilages exactly rac ee in forn 
with this vascular membrane, which was lodge 
in these superficial depressions. The articulz 
cartilages were thinned, and when elevated fro 
the bone a red ulpy membrane, very similar it 
appearance to the free surface which the syna 
membrane presented, was seen. The minut 
pores and perforations in the articular cartilag 
already noticed were evidently formed by th 
action of a pulpy membrane subjacent to the 
and causing their absorption, evidently in th 
same manner, it appears to us, as we find as 
exfoliation from a flat bone of the cranium t 
be perforated by the absorbing powers of t 
gtanulations proceeding from the bone beneat 
it. In examining this preparation, and reflec 
ing on the history of the case, it would appeai 
that when the limb was amputated, the com 
plete destruction of the articular cartilage w: 
in progress. On the free surface towards th 
cavity of the joint, the cartilage was evident 
absorbed by the villous productions from th 
inflamed synovial membrane; on the ossec 
surface the cartilage was acted i by a pulp 
membrane, which existed here also, and it wa 
this membrane which was produced from th 
bone and caused the number of minute perf 
rations already alluded to, having partial 
removed the articular cartilage.* e bone 
were in a condition of hyperemia. This newl, 
formed membrane seems to be endowed with 
power of absorbing, by its villi, the cartilag 
with which it comes in contact; for we mus 
agree with Mr. Key that these vascular fimbris 
or tufts are often buried into excavations in the 
* The preparation is preserved in the muse 1 
