342 



pen that the articulating 1 surfaces remaining long and absolutely motion* 

 less, lose their moisture, and from the want of the fluid which should lu- 

 bricate .them, bring on irritation and adhesive inflammation in each other, 

 either from increased action of the vessels of the perichondrium, or 

 as is believed by Nesbit, Bonn, and others, from an inflammatory state 

 of the fold, which is reflected from the capsule ot the joint over the liga- 

 ment. 



This is the manner in which the disease, termed anchylosis, comes on, 

 a disease improperly ascribed to the congestion of the soft parts, and es- 

 pecially of the ligaments surrounding the articulations. In fact, when in 

 a fracture of the thigh or leg, about the middle of the length of one of 

 these bones, and consequently, at the greatest possible distance from the 

 knee joint, the circumstances of the case require that the bandages should 

 be kept on the limb, a considerable time, the joint loses its power of mo- 

 tion, recovers it with difficulty, and sometimes not at all. I have at 

 present before me, the case of a man in whom a scorbutic affection has 

 delayed, to such a degree, the union of the bone, after a simple fracture 

 of the femur, about the middle of the bone, that it has been found neces- 

 sary to continue, for seven months the use of splints. In the course of so 

 long a state of inaction, the soft parts have lost the habit of moving, and 

 the knee is almost completely ancholysed. 



Whenever, on account of any complaint, one has been confined to bed, 

 the first attempts to walk are painful, difficult, and attended by a marked 

 crepitus in the knee, denoting clearly the want of synovia. On the other 

 hand, if the joint is examined in a person who before death has been 

 Jong without motion, the articulating surfaces will be found rough and 

 dry, with evident marks of iuflammation. Flajani mentions the case of a 

 patient who died after having been three months in bed, in an almost mo- 

 tionless state. Externally, the knees did not appear to have been injur- 

 ed, and yet he could not bend his knee joint. On opening the joint, it 

 was found that the articulating surfaces had grown together ; the poste- 

 rior part of the patella adhered to the condyles of the femur, and it was 

 necessary to use a scalpel to detach these parts from each other. I have 

 frequently observed the same appearance in dissecting the knee joint of 

 persons who died while labouring under white swelling, with or without 

 ulceration. The anchylosis which invariably attends this affection, evi- 

 dently arises from the absolute rest of the diseased joint. 



Anchylosis from want of motion, and consequently from want of syno- 

 via, is not always a partial affection limited to one or two joints ; some- 

 times, it affects several at once, as in the case of the patient whose skele- 

 ton was presented by M. Larrey to the museum of the School of Medi- 

 cine at Paris. One of the most remarkable cases. of universal anchylosis 

 of the joints, is that lately communicated to the National Institute by M. 

 Percy; the patient was an old cavalry officer, who was subject to fits of 

 the gout, and whose articulations, even that of the lower jaw, became stiff 

 and completely lost all power of motion, so that, towards the latter end of 

 hiy wretched existence, he could notbe moved without feeling severe pain 

 in his ancholysed joints. 



From this explanation may be conceived the advantage of moving the 

 lower extremity, when, after a fracture of the leg, the ends of the bone 

 have become sufficiently united lo prevent their being displaced. These 

 motions, which are of indispensable necessity in all fractures of the fe- 

 mur, of the tibia, and especially of the patella, are much better calculated 



