WHITE-SWELLING. 



bones, wafting of the ligaments, and abfcefics in different 

 places. The complaint has invariably proved flow in its 

 progrefs, and fometimes has remained nearly in an indolent 

 ftate for many months, or even for one or two years ; but 

 Mr. Brodie informs us, that he has never met with an in- 

 itance in which a real amendment was produced, much 

 lefs a cure. ( See Medico-Chir. Tranf. vol. iv. p. rzo, &c. ) 

 Mr. Brodie alfo remarks, that the above-defcribed affeftion 

 of the fynovial membrane is rarely met with, except in the 

 knee, and that it generally takes place in young perfons 

 under, or not much above the age of puberty. In the origin 

 of this difeafe, there is a flight degree of ftiffnefs and tume- 

 faftion, without pain, and producing only the moft trifling 

 inconvenience. Thefe fymptoms gradually increafe, fo that, 

 at lall, the joint fcarcely admits of the fmalleft motion, the 

 ftiffnefs being greater than what is the ufual refult of com- 

 mon inflammation. The form of the fwelling bears fome 

 refemblance to that in cafes of inflammation of the fynovial 

 membrane ; but it is lefs regular. The fwelling is foft and 

 elaftic, and gives to the hand a fenfation as if it contained 

 fluid. If only one hand be employed in making the exa- 

 mination, the deception may be complete, and the moft ex- 

 perienced furgeon may be led to fuppofe that there is fluid 

 in the joint when there is none ; but if both hands be em- 

 ployed, one on each fide, the abfence of fluid is diftinguiflied 

 by the want of fluftuation. 



" The patient experiences little or no pain, until abfcefles 

 begin to form, and the cartilages ulcerate ; and even then 

 the pain is not fo fevere as where the ulceration of the carti- 

 lages occurs as a primary difeafe, and the abfceffes heal more 

 readily, and difcharge a fmaller quantity of pus than in cafes 

 of this laft defcription. At this period, the patient becomes 

 affefted with heftic fever, lofes his flefli, and gradually 

 finks, unlefs the limb be removed by an operation." See 

 Brodie's Obf. in Medico-Chir. Tranf. vol. v. p. 251, 

 &c. 



3. Another form of white-fwelling defcribed by the fame 

 writer, is that which is more particularly charafterized by 

 ulceration, of the articular cartilages. This change occurs 

 in the advanced ftage of feveral difeafes of the joints, and it 

 alfo exifts in many inftances as a primary afleftion, in the 

 early ftage of which the bones, fynovial membrane, and liga- 

 ments, are in a natural ftate ; but which, if neglefted, ulti- 

 mately occafions the entire deftruftion of the articulation. 

 When ulceration of the cartilages occurs in the fuper- 

 ficial joints, it conftitutes one of the difeafes which have been 

 known by the name of white-fweUing. From cafes which 

 Mr. Brodie has feen, he is led to conclude, that when it 

 takes place in the hip it is this difeafe, which has been vari- 

 ouflv defignated by writers, the " morbus coxarius," the 

 " difeafe of the hip-joint,'' the " fcrofulous hip," the " fcro- 

 fulous caries nf the hip-joint," &c. At leaft, Mr. Brodie 

 conceives, that it is to this difeafe fuch names have been 

 principally applied, though he acknowledges that there are 

 probably other morbid affeftions whicli have been confounded 

 with it. {Op. Cit. vol. iv. p. 236.) The ulceration of the 

 articular cartilages takes place as a primary difeafe, chiefly 

 in children or adults under the middle age. " Of fixty- 

 eight perfons affefted with this difeafe, fifty -fix (according 

 to Mr. Brodie) were under thirty years of age : the youngeft 

 was an infant of about twelve months ; the oldeft was a 

 woman of fixty." As the knee is more frequently affefted 

 with inflammation of the fynovial membrane, fo is the hip 

 more liable than other joints to ulceration of the cartflaginous 

 furfaces. In general, the difeafe is confined to a fingle 

 joint ; but it is not very unufual to find two or tliree joints 



affefted in the fame individual, either at the fame time or in 

 fucceflion. Sometimes the patient traces the beginning of 

 his fymptoms to a local injury, or to his having been expofed 

 to cold ; but, for the moft part, no caufe can be afligned 

 for the complaint. See Medico-Chir. Tranf. vol. vi. 



For a defcription of the diforder as it occurs in the 

 hip, the reader is referred to the article HlP-/oin/, Difeafe 

 of. At prefent, we ftiall merely notice the fymptoms which, 

 according to the inveftigations of Mr. Brodie, particularly 

 charaSerize ulceration of the cartilages of the knee. They 

 differ from the fymptoms of inflammation of the fynovial 

 membrane, by the pain being flight in the beginning, and 

 gradually becoming very intenfe, which is the reverfe of 

 what happens in the latter affeftion. The pain alfo in 

 the commencement is unattended with any evident fwelling, 

 which never comes on in lefs than four or five weeks, and 

 often not till after feveral months. It is not to be inferred, 

 however, that every flight pain of the joint unaccompanied 

 with fwelling, muft of courfe arife from ulceration of the 

 cartilages. But, fays Mr. Brodie, when the pain continues 

 to increafe, and at laft is very fevere ; when it is aggravated 

 by the motion of the bones on each other ; and when, after a 

 time, a flight tumefaftion of the joint takes place, we may 

 conclude that the difeafe confifts in fuch ulceration. The 

 fwelling arifes from a flight inflammation of the cellular 

 membrane on the outfide of the joint ; it has the form of the 

 articulating ends of the bones ; and for the moft part it 

 appears greater than it really is, in confequence of the 

 mufcles being wafted. No fluftuation is perceptible, as 

 where the fynovial membrane is inflamed ; nor is there 

 the peculiar elafticity, which exifts, where the fynovial 

 membrane has undergone a morbid alteration of its ftruc- 

 ture. 



Mr. Brodie, however, has explained, that, in fome cafes, 

 the fwelling has a different Ihape, and communicates the 

 feel of a fluftuation. This happens when inflammation of 

 the fynovial membrane, attended with a colleftion of the 

 fynovia of the joint, or abfceffes in the furrounding foft 

 parts, or in the articulation itfelf, occur as fecondary dif- 

 eafes. When there has been confiderable deftruftion of the 

 foft parts from abfceffes and ulceration, the head of the tibia 

 may become diflocated and drawn towards the ham. See 

 Medico-Chir. Tranf. vol. vi. p. 326, &c. 



4. There is another fpecies of white-fwelling which is 

 peculiarly different from others, in being attended with ulcer- 

 ation of the fynovial membrane. As, however, it does not 

 appear to us to need a defcription in a work not exprefsly j 

 devoted to furgery, we fhall only add, that the reader may 

 find Mr. Brodie's account of the cafe in the Medico-Chir. 

 Tranfaftions. Thole white-fwellings which are reputed to 

 be fcrofulous, form a fubjeft, however, on which we cannot 

 be filent. In the fcrofulous difeafes of the joints, the 

 bones are primarily affefted, in confequence of which ulcer- 

 ation takes place in tlie cartilages covering their articular 

 furfaces. The cartilages being ulcerated, the fubfequent- 

 progrefs of the difeafe is, according to Mr. Brodie, the 

 fame as where this ulceration takes place in the firft in- 

 ftance. 



It has been a very prevalent opinion, that, in cafes of 

 white-fwelling, the heads of the bones are always enlarged. 

 Mr. Ruffell is, perhaps, the firft writer who expreffed an 

 oppofite fentiment, and he abfolutely declares, that he had 

 never heard nor known of an inftance, in which the tibia was 

 enlarged from an attack of white-fwelling. (On Difeafes 

 of the Knee, p. 37.) We believe, that a regular expanflon 



of 



