WHITE-SWELLING. 



WHlTE-S-welfm^, in Surgery. When a difeafeis attended 

 with great varieties, not only with regard to its progrefs and 

 fymptoms, but alfo its caufe, and the diforder which it pro- 

 duces in the parts which are the feat of it, there is as much 

 difficulty in fixing upon a name that will convey an exaft 

 idea of it, as in offering a definition or defcription of it appli- 

 cable to all the cafes which may prefent themfelves to the at- 

 tentive obferver. Such are the circumftances of the difeafe 

 of which we arc about to fpeak in the prefent article. Sur- 

 geons have given it a variety of appellations, d.rived from 

 feme one particular fymptom with which it is accompanied. 

 Thus, it has been called ivhite-ftudling, (a navne which is 

 ftill mod generally adopted,) becaufe the fkin which covers 

 it retains its natural colour, and exhibits no appearance of 

 inflammation. It is alio fometimes tervae^ fungus arlicuH, on 

 account of its foftnefs and elafticity, which allow it readily 

 to yield to preffure, but make it rife up again immediately 

 when the compreflioa is difcontinued, like the fungous excref- 

 cences which grow upon the oak. The diforder is hkewife 

 often named by foreign writers the lymphatic tumour, or 

 ferous /'welling of the articulations, in confequence of the great 

 quantity of thitk lymph which appears to be effufed in the 

 cellular fubflance around the ligaments, and upon the liga- 

 ments themfelves. Sometimes the difeafe is called fpina 

 ventofa. ( See that article. ) The cafe is occafionally deno- 

 minated a falfs anchylojis, becaufe the difeafe caufes more 

 or lefs interruption of the motions of the joint. Laftly, 

 the diftemper is often called a rheumatic, ox fcrofuhus difeafe 

 of a joint, according as rheumatifm, or fcrofula, is fufpedled 

 of being concerned in its origin. 



White-fwellings are ufually defined to be chronic enlarge- 

 ments of the joints ; circumfcribed ; without any alteration 

 in the colour of the ficin ; fometimes hard, and refilling the 

 preffure of the fingers ; fometimes lefs firm, elaftic, yielding to 

 preffure, and afterwards rifing up again in the manner of a 

 fungus, which grows upon certain trees ; fometimes fo foft 

 as to prefent a deceitful feel of fluftuation, although there 

 is no fluid in the part. In particular infl;ances, thefe fwell- 

 ings are indolent ; but, mod frequently, they are attended 

 with great pain, efpecially when the joint is moved, fo that 

 tlie patient either cannot exercife the limb at all, or does it 

 at the expence of confiderable fuffering, and with imper- 

 feftion and difficulty. The difeafe has its feat in the liga- 

 ments, cellular fubft;ance, fynovial glands, cartilagas, and 

 even the bones. All thefe parts, however, are not afFefted 

 in every inftance ; and fometimes the diftemper commences 

 ill the bones ; fometimes in the cartilages and ligaments, 

 according to the pecuUarity in the nature of the cafe. The 

 foregoing definition is obvioufly merely an enumeration of 

 the principal fymptoms of white-fwellings, and is far from 

 giving an exaft idea of a difeafe which prefents fo many 

 varieties in different individuals, that there are fcarcely two 

 patients to be met with in whom the complaint follows 

 precifely the fame courfe, or exhibits altogether fimilar phe- 

 nomena. 



There is no joint which may not be attacked by this inve- 

 terate difeafe ; but experience proves, that the ginglymoid 

 articulations are more frequently affefted than the orbicular. 

 We are, however, to except from this remark the articu- 

 lation between the femur and os innominatum, in which the 

 difeafe is very common, and often called by the French 

 inrgeons fl>ontaneous diflocation of the femur, becaufe the cafe 

 generally terminates in a difplacement of the head of the 

 thigh-bone. (See Hip-Joint, Difeafe of.) Amongft; the 

 ginglymoid joints, the knee is oftener affefted than any other. 

 Then eome the joints of the elbow, foot, and hand. White- 



fwellings attack the fmall joints, like thofe of the fingers -and 

 toes, with far lefs frequency. 



White-fwellings may occur at every period of life ; but 

 they are more common in infancy and youth than in adulta 

 and old fubjffts. It is conceived alfo by fome writers, that 

 thefe cafes begin more frequently in autumn and winter, or 

 when the atmofphere is damp and variable, than in the other 

 feafons. But the difeafe is on the whole fo common in this 

 climate, that it muft be difficult to eftablifh the truth of the 

 foregoing conjefture. 



The difeafe fometimes begins with a more or lefs acute 

 pain in the articulation, ufually extending along the fafcias and 

 tendons of the neighbouring mufcles. Sometimes the pain is 

 of a dull kind, being fuperficial, feated in the foft parts, and 

 reaching aU round the joint. On other occafions, it is acute, 

 deeplv fituated, and confined to a fmall fpace, which is 

 moftly the very centre of the articulation. In particular 

 examples, the fwelUng of the joint fucceeds a pain which has 

 been experienced in another part of the body, and fuddenly 

 ceafed. Sometimes the difeafe begins in fo unexpefted a 

 manner, that the patient, who went to bed perfeftly well, 

 rifes in the morning with a llifF painful knee. Cafes of the 

 latter kind are generally rheumatic. 



Whatever may be the manner in which the complaint ori- 

 ginates, and whatever the circumftances which precede the 

 attack, it always comes on in the form of a tumour, which 

 prefents the following charafters : — The fwelling feldom 

 reaches all round the articulation ; but is almoft always 

 limited to a more or lefs extenfive portion of the circumference 

 of the part. In the knee, it occurs above the patella, and 

 alfo below this bone, at the fides of the ligament, which con- 

 nefts it with the tibia. In the elbow, it chiefly occupies the 

 fides of the joint, efpecially the inner fide. In the ankle, it 

 takes place below and behind the malleoli. Laftly, in the 

 fingers, it commonly affefts the whole circumference of the 

 difeafed joint. Such fwelling is circumfcribed, immoveable, 

 and more or lefs hard and elaftic, not retaining the impref- 

 fion of the finger, as in oedema (fee (Edema), but ge- 

 nerally communicating, when handled, a fenfation of foft- 

 nefs, which leads to a fufpicion of the prefence of a fluid, 

 when none in reality exifts. The fwelling is more or lefs 

 painful, efpecially when comprefTed. Sometimes, however, 

 it is indolent ; the heat of the part is not increafed, and the 

 integuments continue of their natural colour. The motion 

 of the joint is impeded, and if the patient will not abftain 

 from moving the part, he is put to excruciating pain. There 

 are fome white-fwellings of the knee, in which the leg is- 

 fixed in the extended pofture ; but, moft commonly, the 

 limb is bent, even in a confiderable degree, and when an 

 endeavour is made to ftraighten it, great luffering is excited. 

 In white-fwellings of the elbow, the fore-arm is conftantly 

 obferved in a ftate of flexion. In thofe of the wrift, the 

 hand has a ftrong propenfity to fall into the bent pofition ; 

 and in order to prevent this occurrence, and hinder an in- 

 complete luxation of the carpus from taking place back- 

 wards, the furgeon is fometimes obliged to fupport the hand 

 upon a fplint. 



The conftant flexion of the limb produces a confiderable 

 retraftion of the flexor mufcles and their tendons, together 

 with a rigidity which can be felt through the integuments, 

 which are raifed up by the finews fo affefted. The total 

 lofs of exercife always arifing from this ftate of the mufcles 

 and tendons, generally foon renders the joint ftiflf and mo- 

 tionlefs, fo that it frequently has the appearance of being 

 in a ftate of real and complete anchylofis. See An- 



CHViOSIS. 



The 



