INFLAMMATION OF THE JOINTS. 271 



increase of blood, au infiltration of the small cells, and even dis^in- 

 tegration of the endothelial cartilage, the tissue under it becoming 

 granular. We find quite frequently an accumulation of fibrinous 

 or ''croup-like" membranes, followed by a cicatrization of the 

 synovial membrane. In all acute forms of synovitis we see hem- 

 orrhages in the form of small, tick-like bodies. Inflammation of 

 the joints, when it takes a chronic form, makes the synovial mem- 

 brane thick, tougher, with marked indentations which present a 

 tree-like form. The synovia appears in large quantities, is yel- 

 lowish, clear, or slightly turbid, and dulled by cells or fibrinous 

 flakes. It is very rarely thick. If this synovia is gathered in a 

 large quantity, we see a distention of the capsule, producing a 

 hernia-like protrusion in the parts of the joint where there is the 

 least resistance. Occasionally we find the synovial membrane 

 covered with thick masses of clotted fibres. These occur from the 

 excessive formation of secretion of synovia in the joints. Some- 

 times small bodies appear in the joints due to some parts of the 

 hard cartilage becoming loose, and in rare instances by a breaking 

 ofE of small pieces of bone, and, finally, we may see the develop- 

 ment of a peculiar cicatricial contraction of the synovial mem- 

 brane. This is due to an acute or chronic inflammation of the 

 joints, or when for any cause (for instance, dressing of fractures) 

 a healthy joint is rendered immovable for tome time. This con- 

 dition may produce a temporary stiffening of the joint, but this, 

 as a rule, is overcome in a short time. 



The fibrous capsule of the joint is occasionally inflamed, but, as 

 a rule, in acute and chronic inflammation of the joint it remains 

 unaffected. Where there is suppuration present it may become 

 detached from the periosteum with the bone, and also perforated 

 by the pus. The ligaments are also impregnated with the pus 

 from a purulent inflammation, but they are rarely destroyed. 

 Occasionally, however, we may see in chronic inflammation of tiie 

 joints a cicatricial contraction where the joints become firm and 

 united, immobility being lost. Sometimes from traumatisms we 

 find only the soft parts which surround the joint, such as the exter- 

 nal ligaments, and the neighboring tendons become involved in the 

 inflammatory process, while the inner joint seems to be very little 

 affected. 



The cartilage of the end of the joints is very little affected in 



