64 
On examination, the knee-joint was found 
distended with purulent matter. The syno- 
vial membrane was covered in patches by a 
vascular pulpy membrane ; the cartilages were 
removed in several places. An opening was 
found in the wner condyle of the tibia, which 
perforated the spongy substance of this bone, 
and thus established a communication between 
the interior of the knee-joint and a large 
abscess as it were which had formed under 
the periosteum of the tibia. The shaft of the 
tibia was detached from the epiphysis and the 
riostieum, and was surrounded by matter. 
@ periosteum was thickened, vascular, rough, 
and gritty from minute particles of bone depo- 
sited in it. The ankle-joint was free—The boy 
recovered his health. 
Acute arthritis of the knee may be com- 
bined with acute osteitis of the bones of this 
articulation, and without any discoverable com- 
munication between the cavity of the arti- 
culation and the interior of the bones. On the 
2ist March, 1840, Mr. Smith presented to the 
Pathological Society the following case. Susan 
Christie, zt. 56, an inmate of the House of In- 
dustry, and for along period disabled by the 
affection of the knee-joints which we have 
described as chronic rheumatic arthritis, was 
removed to the Whitworth Hospital, where she 
died of a most acute attack of inflammation of 
the right knee-joint. On the post-mortem exa- 
mination old adhesions were observed in the 
chest. The right knee-joint presented the ex- 
ternal appearances noticed as belonging to the 
chronic rheumatic arthritis in a somewhat ad- 
vanced stage ; moreover, it was greatly swollen, 
and when the synovial membrane was opened 
rulent matter escaped; organizable lymph 
Fined this membrane and the cartilages generally. 
These structures, however, were in some places 
removed altogether, their place being supplied 
by a porcelainous deposit, grooved in the line 
of flexion and extension. From the condyles 
of the tibia the cartilage was raised up from the 
bone, apparently stretched out, and converted 
into a thin, flexible, and soft yellow membrane, 
difficult to be distinguished, except by its si- 
tuation, from a deposit of lymph the produce 
of recent inflammation. 
But the interior of the head of the tibia, 
its cancellated structure, the medullary mem- 
brane lining these cancelli, and the membrane 
of the medullary canal itself, all presented evi- 
dences of their having been the seat of acute 
inflammation. The purulent matter was dif- 
fused through the cancelli of the tibia, from 
the knee-joint, for one-third of its extent, but 
was nowhere collected into any isolated cavity 
or abscess, nor was there any communication 
between the purulent matter which occupied 
the synovial sac of the knee-joint, and that 
which pervaded the medullary structure and 
cancellated tissue of the tibia. In a word, the 
anatomical characters of a true acute osteitis 
of the bones entering into the formation of 
the knee-joint coexisted in an advanced stage 
with those of acute inflammation of all the 
other structures of the articulation. 
The osteitis of the lower extremity of the 
ABNORMAL CONDITIONS OF THE KNEE-JOINT. 
femur or upper portion of the tibia sometim 
presents more of a chronic character. T 
flammation of the interior of the bone 3 
proceed to cause the death of a portion, wh 
is converted into a sequestrum, the presences 
which becomes a source of irritation and — 
flammation of the surrounding bone and 
formation of an abscess. The following ¢ 
came under the writer’s observation while un 
the care of his colleague Dr. Hutton in 
Richmond Hospital. Thomas Conolly, et. 
was admitted in May, 1838, for a disease 
the lower extremity of the left femur, of mi 
years’ duration. He had long suffered from 
deep boring pain in the interior of the bo 
At length an abscess formed, matter made 
way to the surface and was evacuated, a 
two small fistulous openings remained, throu: 
which a probe could be antsy deep into 1 
interior of the enlarged femur. The man w 
greatly exhausted by the quantity of the dis 
charge, by confinement, and heetie fever, a 
amputation was performed in the femur jus 
above the diseased part. The femur was four 
much enlarged near the knee-joint, and cover 
by wasted muscles, which had undergor 
considerable degree of fatty degeneration. Whe 
these were removed, the periosteum was foun 
thickened. A vertical cut from. before back 
wards was made through the femur, kn 
joint, and tibia, by which section the cavity : 
an abscess capable of containing a hen’s eg 
was exposed, which was placed transverse 
between the condyles, having two open fists 
lous orifices, one on the inner, the py on th 
external condyle. This abscess was lined by 
thick membrane which by a fine injections va 
proved to have been highly vascular; vil 
flocculi hung from it into the interior of the ea 
vity ; a dark-looking sequestrum of a cylin 
drical form, an inch and a half long and ha 
an inch thick, occupied the superior half of th 
cavity; one end of the sequestrum was fixe 
into the bony tissue of the femur, as if 
were on its way to present itself at the oute 
fistulous orifice ; the remainder of it lay dia. 
gonally across the cavity of the , th 
front wall of which was principally constitutec 
of soft parts, the femur having been absorbe 
in this situation. In the vicinity of the ab 
scess, particularly above it, the bone was greatly 
thickened, its cancellated structure solidifies 
and rendered apparently as dense as ivor 
The interior of the joint was quite unconnecte 
with the cavity of the abscess, but the joint 
self presented evidence of its having been ; 
one time the seat of some form of inflam 
matory action, because the shape of the con 
dyles of the femur was somewhat altered, am 
at the same time thetibia was partially displace 
backwards, and ligamentous anchylosis 
taken place. The cartilage had been remoy 
somewhat from the ends of the bones, and i 
place supplied in patches by a membrane like 
periosteum, and in other situations by a dense 
polished enamel. It was to be inferred fro 
the appearances which the bones and cont 
guous structures presented, that the knee-join 
had latterly been quite useless. > 
