JOINTS. 



liable to have the inflammation communicated to them. 

 Part8 partaking of a cartilaginous ftrufture being very in- 

 capable of bearing the irritation of difeafe, are often ab- 

 forbed, fo that, in the inllance before us, a portion, or the 

 whole of the articular furface of the bones, may be left com- 

 pletely denuded of its natural cov-ering. At length the 

 heads of the bones entering into the formation of the af- 

 feded joint inflame, and become carious. 



Sometimes only fuch parts as are exterior to the capfular 

 ligament of the joint are inflamed, and in this cafe the fymp- 

 toms are never fo fevcre, nor fo obllinate, as when the com- 

 plaint is more deeply fituated. Even when fuppuration 

 takes place on the outfide of the capfule, the cafe is not 

 dangerous, provided the cavity of the joint be not involved 

 in the inflammatory attacks. Every inflammation of a large 

 joint may generally be cor.fidered as a cafe of confiderable 

 importance ; yet certainly there are inftances where the in- 

 flammation being mild in degree, and fimple in its nature, 

 the danger is not urgent. However, every furgeon ought 

 to be well imprefled with the faft, that though the inflam- 

 mation be originally of a healthy fort, it is always very 

 likely to be converted into on? of a fpecific nature, whenever 

 there is a tendency in the conilitution to fcrofulous difeafe. 

 A perfon, whofe habit is fcrofulous, may fometimes con- 

 tinue, during life, exempt from any local difeafes of this 

 fpecifie nature, provided he be fortunate enough to avoid 

 all irritation of parts on which fcrofula is moil particularly 

 difpofed to make its attack. Among fuch parts we mull 

 clafs the joints, efpccially tJie knee, hip, elbow, and ankle. 

 Hence, when a joint is inflamed, how mild foever the affec- 

 tions may be, we ought never to forget, that when there is 

 a tendency to fcrofula in the fyilem, the original cafe of 

 fimple inflammation is very apt to be the exciting caufe of 

 the white fwelling, one of tlie mofl; fevere and intractable 

 difeafes which increafe the catalogue of human miferies. 

 Hence the prudence of adopting with exaclnefs whatever 

 method of treatment may be uidicated. In the following 

 obfervations, we (hall fuppofe the cafe to be that of an in- 

 flamed knee. The means bell calculated for the relief of an 

 inflamed joint are, generally fpeaking, thofe which are called 

 antiphlogifl;ic. There are few cafes in which j^eneral and 

 topical bleeding is more neceflary and ufeful. The violence 

 of the inflammation, and the llrength, age, and pulfe of the 

 patient, mufl; determine with what freedom the lancet Ihould 

 be employed. Leeches, however, may always be applied, 

 and their application be repeated feveral times with advan- 

 tage. When the leeches have fallen off, the bleeding is to 

 be promoted by fomenting the part. The furgeon (hould 

 daily perfiil in this method, until the acute ftage of the rn- 

 flarrmation has entirely fubfided. In conjuniflion with this 

 ■treati';;!.:; lie (hould take care to keep the joint continually 

 furro'.inded with linen wet with the faturnine lotion. In no 

 cafe of inflammation are the application of cold lotions, and 

 the maintenance of a confl:ant evaporation from the furface of 

 the part a.Tefted, more fl:rikingly advantageous. 



Fomentations and emollient poultices, however, fometimes 

 afford moll eafe to the patient, in which circumftance they 

 .ought to have the preference. 



Together with the foregoing means, laxative and febri- 

 fuge medicines are to be exliibited, and in a cafe of fevoie 

 pain and lofs of flcep, opiates. 



When the acute ftage of the inflammation has abated, 

 -the plan of treatment may be a little altered. The grand 

 objeil is now to remove the elTetls which have been left by the 

 preceding afTeftion. Thefe are a thirkened ftate of the cap- 

 fular ligament, and parts furrounding the articulation ; a 

 itiffnefs of the joint, and pain whea it is moved ; a colicclioii 



of fluid in the capfule, &c. This ftate of the complaint, 

 when neglected, and there is a tendency to fcrofula, may 

 prove exceedingly obllinate, and even terminate in an irre- 

 mediable ipecific dilk-mper of the joint. When, therefore, 

 the local rednefs, tenfion, and throbbing, and the fymptoms 

 of inflammatorj" fr"«'r fiibfide, the aClivily of the praftitioner 

 ought not to be relaxed, 'i ne application of a bUder to 

 the joint will now be found particularly efficaciO'J", *ad the 

 difcharge (hould be kept up for a few days with the favin 

 cerate. Very large collections of fluid in the capfular liga- 

 ment of the knee, great thickening about the joint, and 

 other remaining effefts of inflammation, may often, under 

 fuch treatment, be quite got rid of in a week or ten days. 



In other cafes, in which the inflammation and its effecls 

 are flighter, lotions compofed of fpirit of v.-ine, vinegar, and 

 fal ammoniac, fuffice for the removal of any chronic com- 

 plaints which may continue after the acute inflammation is at 

 an end. 



When the inflammation of a large joint like the knee is in- 

 duced by a wound, the flomach is often much affedled, and 

 the lymptoms may be very violent and even fatal. 



Of Preternatural Cartilaginous Sub/lances in Joints. — The 

 ancients have either negledted to notice this difeafe in their 

 writings, or they have not been at all acquainted with it. 

 Ambrofe Pare is the firfl author who mentions it : he had 

 made an incifion, in order to difcharge fome fluid from the 

 cavity of the knee-joint, when a hard, pohlhed, white body, 

 about as large as an almond, was difcharged from the wound. 

 (Livre 35. chap. 15.) Since the time of Pare, the com- 

 plaint has been defcribed by numerous furgical authors ; but 

 the moil valuable information on the fubjeft may be found in 

 the works of Reimarus, Morgagni, Bromiield, Ford, 

 Default, Home, Hey, and Abernethy. 



The external part of the extraneous fubilances, to which 

 allufion has been made, is in general of a cartilaginous con- 

 fluence, while their central part is frequently ofl'eous. Their 

 figure is fubjedl to great variety ; but they ufually have one 

 concave fide, and another which is convex. They are, for the 

 moil part, formed in the knee, and have been fuppofed by 

 Reimarus, and a few other writers, to be met with in no 

 other articulation. Morgagni, however, has feen oflilied 

 bodies of this kind in the ankle-joint. Haller, alfo, dif- 

 covered a great number of cartilaginous bodies in the arti- 

 culation of the jaw, where the natural cartilages had been 

 deftroyed. Mr. Hey, of Leeds, mentions a cafe, in which 

 there were two bodies of this defcription in the elbow-joint. 

 The largeft; preternatural cartilage perhaps ever met with is 

 mentioned by Mr. Home, as being nearly equal in fize to 

 the knee-pan itfelf, end litualed in the knee-joint of a fol- 

 dier, belonging to the juth regiment. The greatefl: num- 

 ber ever known to be contained in one articulation is twenty- 

 five. In mod inftances, we only find one. 



Tl'.cfe preternatural cartilaginous fubilances are either at- 

 tached to fome part of the infide of the joint, or they are 

 quite unconneftcd, loofe, and moveable. It is only when 

 they become fo iituated, as to intcrpofe themfelves between 

 two articular furfaces, which ghde over each other in the 

 motion of a limb, that much inconvenience commonly re- 

 iults from their prefence. Wiiile they continue by the fide 

 of the patella they caufe but iittle trouble ; but when they 

 flip under the ligament of that bene, or between the fame 

 bone and the condyles of the femur, or between the latter 

 bone and the head of the tibia, then they impede progref- 

 fion, caufe confiderable pain, and often excite inflam- 

 mation. 



Much light was thrown upon the formation of loofe cartil?- 

 ginous tumours in ii.e joiiitf, by the penetrating genius cf 



the 



