WHITE-SWELLING. 



of the heads of the bones, in cafes of white-f welling, is far 

 from being an ufual occurrence, although it may fometimes 

 happen. It is frequent, however, to meet with a fort of 

 enlargement, which arifes from fpiculs of bony matter, 

 depofited on the outfide of the tibia, ulna, &c., which 

 alteration is materially different from a regular expanfion of 

 the heads of thofe bones. We have, however, lately feen 

 an inftance, in which the upper head of the ulna is confider- 

 ably increafed in fize by a regular kind of txpanfion. The 

 preparation is in Mr. Abernethy 's mufeum ; and a few other 

 fpecimens have, we believe, been occafionally noticed. Yet, 

 as a general faft, we may ftill remark, that an enlargement 

 of the heads of the bones in the difeafes called white-fwelling, 

 is far from being the ufual ftate of things. The change 

 which the head of the tibia undergoes in many cafes, is lirft: 

 a partial abforption of the phofphate of hme throughout its 

 texture, while a foft kind of matter is fecreted into its fub- 

 ftance. In a more advanced llage, and, indeed, in that ilage 

 which mod frequently takes place before the limb is ampu- 

 tated, there are deep excavations in the head of the bone, 

 arifing from caries, and its flrufture is now fo foftened, that 

 when a probe is preffed againft the carious part, it readily 

 penetrates deeply into the bone. 



Mr. Brodie alfo joins in the opinion, that the morbid 

 affeftion has its origin in the bones, " which," he fays, 

 " become preternaturally vafcular, and contain a lefs than 

 ufual quantity of earth, while, at firft, atranfparent fluid, and 

 afterwards a yellowifh cheefy fubftance, is depofited in their 

 cancelli. From the difeafed bone, vefTeh, carrying red 

 blood, (hoot into the cartilage, which afterwards ulcerates 

 in fpots, the ulceration beginning on that furface which 

 is connefted to the bone." Med. Chir. Tranf. vol. iv. 

 p. 272. 



With rcfpeft to the expanfion of the heads of the bones, 

 we ought to have mentioned, that the late Mr. Crowther 

 entirely diibelieved the reality of the occurrence, and every 

 body knows, that he paid very confiderable attention to the 

 fubjeft. (See Praft. Obf. on White-SweUing, &c. edit. 2. 

 p. 14.) The event, however, (liould have been defcribed 

 as unufual, and not as never happening, fince, as we have 

 already dated, a few fpecimens of fuch a change have now 

 been collefted. 



Mr. RulTell has particularly noticed how much the foft 

 parts frequently contribute to the fwelling : " the great mafs 

 of the fwelling," he obferves, " appears to arife from an 

 affeftion of the parts exterior to the cavity of the joint, and 

 which, befides an enlargement in fize, feera alfo to have 

 undergone a material change in ftrufture. There is a larger 

 than natural proportion of a vifcid fluid, intermixed with the 

 cellular fubltance ; and the cellular fubftance itfelf has 

 become thicker, fofter, and of a lefs firm confidence than in 

 a ftate of health." (On the Morbid Aff'eftionsof the Knee, 

 p. 30. ) The manner in which the foft parts are affedled 

 is alfo defcribed by Mr. Brodie. " Inflammation takes 

 place of the cellular membrane, external to the joint. Se- 

 rum, and afterwards coagulable lymph, are eff^ufed ; and hence 

 arifes a puffy eladic fwelhng in the early and an oedematous 

 fwelling in an advanced itage of the difeafe. Scrofula 

 attacks only thofe bones, or portions of bones, which have 

 a fpongy texture, as the extremities of the cylindrical bones, 

 and the bones of the carpus and tarfns ; and hence the 

 joints become affeftfd from their contiguity to the parts 

 which are the original feat of the difeafe." Med. Chir. 

 Tranf. vol, iv, p. 273. 



All wliite-fwellings which make confiderable progrefs, 

 and occaCon fevere pain, long confinement, abfce/Tes, Sec. 



unavoidably bring on that impairment of the general 

 health, which is well known by the name of hedic fever. 

 The patient gradually lofes his appetite and natural reft 

 and fleep ; his pulfe is fmall and frequent ; an obftinate 

 debihtating diarrhoea, and profufe noaurnal fweats, enfue. 

 Such complaints are fooner or later followed by diffolution, 

 unlefs the conftitution be relieved in time, either by the 

 amendment or removal of the difeafed part. In different 

 patients, however, the courfe of the difeafe, and its effefts 

 upon the fyftem, vary confiderably in relation to the rapi- 

 dity with which they occur. 



Rheumatic white-fwcUings are very diftinft difeafes from 

 the fcrofulous diftemper of the large joints. In the firft, 

 the pain is faid never to occur without being attended with 

 fwelling. Scrofulous white-fwellings, on the other hand, 

 are always preceded by a pain, which is particularly con- 

 fined to one point of the articulation. In rheumatic cafes, 

 the pain is more general and diffufed over the whole joint. 



It feems probable, that all cafes in which the ftrutlure of 

 the bones is found quite undifeafed, and in which all the 

 mafs of difeafe appears to be confined to the foft parts, are not 

 fcrofulous white-fwellings. Few perfons who have at- 

 tained the age of five-and-twenty, without having had the 

 leaft fymptom of fcrofula, ever experience, after this period 

 of hfe, a firft attack of the white-fweUing of the fti umous 

 kind. All cafes, in which the internal itrufture of the 

 heads of the bones becomes foftened, are probably fcro- 

 fulous. 



Mr. Ruffell has noticed the frequent enlargement of the 

 lymphatic glands in the groin, in confequence of the irrita- 

 tion of the difeafe when in the knee ; but, he juftly adds, 

 that this fecondary affedlion never proves long trouble- 

 fome. 



When the bones are difeafed, the head of the tibia always 

 fuffers more tlian the condyles of the thigh-bone. ( Rujfell. ) 

 The articular furface of the femur fometimes has not a 

 fingle rough or carious point, notwithftanding that of the 

 tibia may have fuffered a great deal. The cartilaginous 

 coverings of the heads of the bones are generally eroded 

 firft at their edges ; and in the knee, the cartilage of the 

 tibia is always more affefted than that covering the condyles 

 of the thigh.bone. Indeed, when white-fwellings have their 

 origin in the bones, and the knee is the feat of the diforder, 

 there is fome ground for fuppofing that it is in tlie tibia 

 that the morbid mifchief firft commences. 



The ligaments of the knee are occafionally fo much 

 weakened or deftroyed by this terrible malady, that the 

 tibia and fibula become more or lefs diilocated backward, 

 and drawn towards the tuberofity of the ifchium, by the 

 powerful aitioii of the flexor mufcles of the leg. 



We have feen a curious fpecies of white-fweUing, in 

 which the leg could be moved to each fide a very confider- 

 able diftance, both when the knee was extended and bent. 

 Such a ftate implies a preternatural loofenefs of the liga- 

 ments of the articulation. 



Scrofulous white-fwellings, no doubt, are under the 

 influence of a particular kind of conftitution, termed a fcro- 

 fulous or ftrumous habit. In this fort of temperament, 

 every caufe capable of exciting inflammation, or any morbid 

 and irritable ftate of a large joint, may bring on fuch dif- 

 order as may end in the fevere difeafe of which we are now 

 fpeaking. 



In a man of a found conftitution, an irritation of the kind 

 alluded to might only induce common healthy inflammation 

 of the affeded joint. 



In fcrofulous habits, it alfo feems probable, that irrita- 

 tion 



