WHITE-SWELLING. 



The fwelling may remain a long while in the condition 

 which has been defcribed ; it may even ceafe to be painful ; 

 and it may caufe only a ferious weaknefs of the knee, and 

 more or lefs difficulty in walking. But moft commonly it 

 continues to make uninterrupted progrefs ; or, if its ad- 

 vances fhould happen to be checked, and the difeafe be for 

 a time ftationary, it frequently occurs, that, in confequence 

 of a fall, a bruife, or even without any external caufe, and, 

 as it were fpontaneoufly, the complaint afterwards increafes 

 again. The articulation fwells more and more, and, if it be 

 the knee which is affefted, the hollow of the ham alfo fwells 

 up and becomes effaced. The pain likewife augments, being 

 ■felt fometimes at one point of the circumference of the joint, 

 fometimes at another ; occafionally in the ham, and, in 

 other examples, in the very cavity of the articulation. There 

 are, however, fome patients who feem to fufFer little or no 

 pain of any confequence. The hardnefs of the tumour is 

 fubjeft to great variety. The older the difeafe is, the more 

 conliderable is in general the degree of induration. Yet 

 there are certain white-fwellings which are extremely hard, 

 although they have not exifted a long while ; and other 

 cafes which are very foft, notwithftanding they are of long 

 ftanding. Boyer thinks, that this difference depends upon 

 the feat of the difeafe, which is fometimes in the bones ; 

 fometimes in the ligaments and furrounding cellular mem- 

 brane. The (Icin which covers the fwelling grows thin, 

 pale, and (hining ; the cutaneous veins become dilated and 

 varicofe ; and the mufcles of the leg wafte and dwindle 

 away, fo that the fize of this part of the limb is (Irikingly 

 diminifhed. Sometimes, however, it is aifefted with oedema, 

 and has the appearance of being enlarged. The lower part 

 of the thigh alfo frequently undergoes a very confiderable 

 <iiminution. This wafting of the limb above and below the 

 difeafe, makes the joint alfo feem much more fwelled than it 

 is in reality. Sometimes the lymphatic glands in the groin 

 become enlarged and hardened ; and when the difeafe makes 

 much progrefs, the bones are frequently foftened and carious, 

 and the cartilages deftroyed. Laftly, abfceffes, more or lefs 

 confiderable, are formed in different parts of the tumour ; and 

 their formation is attended with a great deal of acute pain, 

 inflammation, and fever. Thefe abfceffes are more or lefs 

 deeply fituated, and often communicate with the interior of 

 the joint. When they burft, or are opened, a large quantity 

 of matter is difcharged, which is hardly ever of healthy con- 

 fifteiice, being moftly a fero-purulent yellowifli fluid, fome- 

 what refembhng turbid whey, and containing flakes of albu- 

 men. Sometimes, however, it prefents very nearly the ap- 

 pearances of healthy pus ; but it foon changes into a thin 

 fetid fanies of very bad quality. Its difcharge, although 

 very confiderable, is followed by fcarcely any perceptible 

 diminution in the fize of the fweUing. The openings by 

 which it efcapes fometimes foon clofe, and frefli coUeftions 

 of matter enfue which burft of themfelves, and then heal 

 up like the former ; but, in general, the apertures, inftead 

 of healing, become converted into incurable fiftuls. 



Mr. Brodie has paid confiderable attention to the feveral 

 difeafes of the joints, which ufually go under the name of 

 white-fwelling. In particular, he has carefully examined 

 the morbid appearances which are found upon difTeflion ; 

 and his obfervations have led him to propofe a claflification 

 of thefe difeafes. 



I . The firft cafe which Mr. Brodie defcribes is, injlamma- 

 tton of the fynov'tal membrane, which may occur as a fymptom 

 pf a conititutional difeafe, where the fyftem is affefted with 

 rheumatifm ; where mercury has been improperly exhibited, 

 f>T in large quantities ; or where there is general debility 



from any other caufe. But, in thefe cafes, the inflammation 

 is feldom fevere ; it occafions an effufion of fluid into the 

 joint, but rarely terminates in the extravafation of coaguia*- 

 ing lymph, or thickening of the inflamed membrane. Some- 

 times it leaves one joint to attack another ; or, it fuddenly 

 fubfides without another joint becoming affefted. 



At other times, fays Mr. Brodie, the inflammation occurs 

 as a local affeftion produced by a fprain, the application of 

 cold, or arifing from no evident caufe. It is then, for the 

 moft part, more fevere, and of longer duration ; it leaves the 

 joint with its funftions more or lefs impaired, and occafion- 

 ally terminates in its total deftrudlion. In itfelf, it is a 

 ferious difeafe ; but it is often confounded, under the general 

 name of white-fwelling, with other difeafes ftill more ferious. 

 In fome cafes, it affumes the form of an acute ; but in the 

 greater number of inftances, it has that of a chronic inflam- 

 mation. 



When the cafe is acute, the fliin is in general red, and the 

 joint tender and painful. The pain, which is not confined 

 to any particular point, and aggravated by motion of the 

 limb, is foon followed by fweUing. The patient is alfo 

 affefted with inflammatory fever. In a few days, the 

 difeafe either fubiides altogether, or alTumes the chronic 

 form. 



According to Mr. Brodie, when the inflammation is chro- 

 nic, the pain and tendernefs are lefs, fo that the patient is 

 able to walk about, and often without experiencing any 

 fevere diftrefs. There is no fever, and the fkin retains its 

 natural colour. The fwelling alfo increafes lefs rapidly 

 than in acute cafes. Thefe fymptoms are generally rendered 

 worfe by expofure to cold and exertions. In the firft in- 

 ftance, the fwelling of the joint arifes entirely from a preter- 

 natural quantity of fynovia. But when the inflammation 

 has exifted fome time, the fluid is not fo plainly perceptible, 

 becaufe the fynovial membrane is now thickened, which like- 

 wife augments the ftiffnefs of the articulation. The fliape 

 of the fwelling is not that of the articulating ends of the 

 bones, but arifes chiefly from the diftended ftate of the 

 fynovial membrane, and hence depends in a great meafure on 

 the fituation of the ligaments and tendons, which refift it in 

 certain direftions. Thus, when the knee is affefted, the 

 fwelling is principally obfervable in the fame places where it 

 occurs in cafes of hydrops articuli. 



After the inflammation of the fynovial membrane has fub- 

 fided, the fluid is abforbed, and, in fome inftances, the joint 

 recovers its natural figure and mobility ; but in the majo- 

 rity of cafes, the ftiffnefs and fwelling continue. Whenever 

 the patient is expofed to cold, or exercifes the limb much, 

 the pain returns, and the fwelling is increafed. Such cafes 

 are of frequent occurrence, and, as Mr. Brodie obferves, 

 they form a large proportion of thofe difeafes which are 

 called white-fwellings. 



Long-continued and negledted inflammation of the fyno- 

 vial membrane fometimes terminates in the formation of an 

 abfcefs in the joint, in ulceration of the cartilages, and de- 

 ftruftion of the articular furfaces. Medico-Chir. Tranf. 

 vol. V. p. 240, &c. 



2. The fame gentleman has favoured the public with a 

 very circumftantial hiftory of another defcription of cafes, 

 where the difeafe originates in the fynovial membrane, which 

 lofes its natural organization, and becomes converted into a 

 thick pulpy fubftance of a light brown colour, interfefted 

 by white membranous lines, and from one-fourth to one- 

 half of an inch, or more, in thicknefs. As this difeafe ad- 

 vances, it involves all the parts of which the joint is com- 

 pofed, producing ulceration of the cartilages, caries of the 

 3 E 2 bones, 



