Fig. 2. 
! i 
Well fifi 
Left knee-joint, front view. 
The prominent swelling on the left, A, is from the en- 
wf head of the tibia; that on the right, B, is the 
Hi 
_ soft globular swelling resulting from the effusion into 
___ the synovial membrane. 
per and projecting margin of the inner condyle 
of the tibia: it leans to the inner hamstring 
muscle. The rest of the popliteal space pre- 
sents a normal appearance. hen the limb is 
| fully extended, and the muscles are allowed to 
‘remain in a passive state, the patella may be 
| moved from side to side with much freedom. It 
‘appears to float as it were on the surface of an 
‘accumulated quantity of synovial fluid. When 
pressed against the trochlea of the femur, this 
fluid is moved laterally, and the patella strikes 
against the femur, and if a lateral movement be 
‘ow communicated to this bone, a grating of 
‘rough surfaces may be perceived. If we grasp 
‘the leg and flex it on the thigh, we find we can 
elicit a peculiar articular crepitus. . In this case 
‘it is quite audible, and resembles much the 
noises which electric sparks make when dis- 
‘charged in quick succession from an electrical 
apparatus. When the limb is much flexed, 
‘the swelling of course feels remarkably hard 
and solid, but when the limb is again brought 
back to its ordinary state of extension, fluctua- 
‘tion may be felt very evidently in it over its 
whole surface. The popliteal bursa, however, 
is felt very tense in the extended position of 
the joint, as when the patient stands and throws 
his weight on the limb. If we feel this bursa, 
and then cause the patient’s limb to be flexed, 
we can follow the fluid, as it were, with our 
fingers into the articulation. As the patient 
lies in bed, the limb left in the extended posi- 
ABNORMAL CONDITIONS OF THE KNEE-JOINT. 
59 
Left knee-joint, side view, shewing the enlarged bursa 
._ in the popliteal space. 
tion, and the synovial sac as flaccid as possible, 
moveable bodies may be detected in its interior. 
Some appear to be adherent, and situated more 
particularly in the upper portion of the sub- 
crural bursa. When we elevate the leg, and 
preserve it still in the fully extended position, 
the patient, without any apprehension of pain, 
will permit us to press it firmly against the 
femur, and does not experience the least suf- 
fering even if we strike the heel forcibly. (See 
HIP, ABNORMAL CONDITION OF.) 
Both knee-joints in this case are affected 
with this disease, but the left is more distended 
by fluid than the right. The inner condyles of 
the femur and tibia of this limb are thrown 
somewhat inwards, and form a salient angle in 
this direction, which, the patient says, is cer- 
tainly the result of disease, as his limbs were 
perfectly straight before he was visited by his 
present illness. 
Although his knee-joints are more affected 
with this chronic disease, his other joints pre- 
sent very evident traces of this afflicting malady. 
The disease in him followed a rheumatic fever, 
which was brought on in consequence of his 
having lain a whole night asleep on a wet road, 
having fallen unobserved from fis cart when in 
a State of intoxication. 
Although this is not the place to speak of 
treatment, we may be permitted to say that 
under the influence of rest in bed and a mild 
mercurial course, followed by a long-continued 
use of sarsaparilla with large doses of the 
hydriodate of potass, this man left the hospital, 
by no means cured, but much improved and 
tolerably well able to follow his occupation. 
