58 
When the distension of the synovial sac of 
the articulation is at its maximum, we usually 
notice in this disease a prominent tumour about 
the size of a small hen’s egg projecting into 
the popliteal space (fig. 3). is tumour 
leans towards the inner head of the gastro- 
cnemius ; it disappears when the knee is flexed, 
and becomes more tense and hard when the 
limb is in the extended posture, as when the 
patient stands erect. We have known several 
cases of this disease of the knee-joint, where 
the synovial sacs of the knees have been much 
distended, and have on these occasions almost 
uniformly observed this popliteal tumour formed. 
From its situation, and from negative evidence, 
we can readily infer that the swelling consists 
of synovial fluid contained in a bursa, which 
has a communication with the interior of the 
knee-joint. 
We have witnessed very many cases of this 
chronic rheumatic arthritis of the knee, in which 
this dropsical condition of the popliteal bursa 
existed, and some of these having had this 
chronic disease in both knee-joints, the burse 
were seen in both popliteal spaces,—presenting 
in these cases on a superficial inspection the 
resemblance to a case of double popliteal 
aneurism. 
We have also enjoyed an opportunity of 
ascertaining by anatomical examination the real 
condition of this synovial sac in this disease, 
and its relation to the synovial membrane of 
the joint itself, to which we shall have occasion 
just now to revert. 
When the palm of the hand is applied over 
the patella in the early stages of the affection, 
a sensation of a preternatural degree of heat is 
felt; and when pressure is made on the patella, 
and a lateral movement across the condyles is 
communicated to it, a very evident roughness 
is perceived, either on the articular surface of 
the patella itself, or the corresponding surface 
of the trochlea of the femur; and when the 
knee-joint is fully flexed, a charactenstic arti- 
cular crepitus becomes manifest. In the later 
stages of the disease, the subacute inflamma- 
tion, with the phenomena which it presents, 
subsides, the synovial fluid becomes absorbed, 
and the patella falls down on the trochlea of 
the femur; the popliteal bursa also disappears, 
and the grating produced by rubbing surfaces 
is perceived by the patient himself in all his 
movements, and can even be heard by the by- 
standers. If the joint be now examined care- 
fully by the surgeon, he feels satisfied that the 
smooth cartilage has been removed, either par- 
tially or completely, from the articular surfaces. 
Crests of ossific deposit may even be per- 
ceived, and, almost invariably, foreign bodies 
may be felt in the interior of the joint. Some 
of these are superficial, small, and moveable ; 
others are evidently situated more deeply in 
the interior of the joint. Some are small, 
some , and we have known one case, 
which we learned to be of forty years standing, 
in which numerous bodies* of this description 
* The case mentioned by Morgagni in which he 
Saw twenty-five of these bodies in the left knee- 
ABNORMAL CONDITIONS OF THE KNEE-JOINT. 
could be felt, some literally as as the 
a floating about in the interior of the 
nee-joint, and which, we doubt not, we 
exactly of the same nature as those we k 
described in the elbow-joint. ; 
The osis in this disease must be w 
favourable, as it seldom yields to medicine, t 
it does not appear to us to shorten life. W 
have seen an example in which the knee-jon 
had been affected with this disease, as | 
patient herself reported, for forty years. 
are not prepared to say, however, that medic 
and proper treatment may not i 
short the disease, and we are sure the sufferin 
of the patient may be palliated at least I 
appropriate treatment. e following case | 
good example of this disease. 
Case of chronic rheumatic arthritis.—Patri 
Donohoe, 38, a carter, admitted into tl 
Richmond Hospital, (Dublin,) Nov. 24, 18 
complained of chronic pains in all his jon 
but the principal source of his uneasiness 
the diseased condition of his knee-joints, 
pecs his earning his livelihood. 
nee-joints were greatly swollen; he co 
plained of stiffness of them, and of some pa 
at the inner condyle of the tibia, which in 
creased when he stood up; yet he was able t 
walk a considerable distance. The limbs cou 
be fully extended, and when in bed he key 
them pretty constantly in this position. H 
could not fully flex them backwards. 
swelling of the knees differs from that of a 
ordinary white swelling, although it might 
respond much to the characters which a cas 
of chronic synovitis of the knee might pre 
or to a case which the older writers denomin 
hydrops articuli. The swelling viewed in 
is of an irregular globular form, involving th 
patella, its ligament, and the hamstring | 
dons in one uniform tumour; on the contra 
the ligamentum patella can be felt, with if 
edges as yet sharp and well defined, when th 
patient is desired to exert the extensor muscle 
of the leg. The tibia at the side of the li 
ment, as far as the insertion of the intern 
lateral ligament, can be plainly felt th 
the skin to be rough and scabrous, and it 
be ived that this part of the bone is be 
with bony vegetations. The breadth of # 
head of the tibia is increased; the synovi 
membrane contains a redundant secretion, whit 
elevates the vastus internus and forms a swell 
here which measures about seven inches in | 
vertical diameter, and which seems to be som: 
whatconstricted transversely in its centre (fig. 
The swelling of the knee on the outside is evide: 
enough, but is not so well marked as that: 
the inner side. 1t presents no transverse b 
subdividing it into two tumours. The ou 
line of the hamstring tendons is seen, whi 
the joint is viewed in profile, either fro 
without or within, and a very well defined ove 
projection from the popliteal space is observes 
(fig. 3). Its centre is on a level with the P 
joint of an old woman who died of apoplexy, we 
think must have been a case of the chronic disea 
we are now describing. 
