ON CARPITIS. 6(59 
more of the lower joints of the carpus, with or without a deposit of 
osseous matter externally. 
The inflammation of synovial membrane will generally be 
present with the foregoing state, but it may exist alone, in which 
case it is often a result of external injury, such as bruises on the 
front of the knee or from speedy-cutting. In the more advanced 
stages of disease the synovial membrane and the ligaments are 
both affected ; and, as disease progresses, we find that the one is 
destroyed by ulcerative absorption, and the other absorbed and 
replaced by osseous matter : still advancing, we find that the 
articular cartilage is partaking of disease, the ulcerative absorption 
extends to it, and proceeds to the body of the bone itself, ending in 
caries. 
The fifth form is a curious one ; but I am disposed to believe, 
from the observations I have made on some few particular cases, 
that such state will occur. 
In a joint like the knee, composed of parts but sparingly sup- 
plied with vessels and nerves, it cannot be expected to find much 
heat ; this is more often manifested in a part which is well sup- 
plied with both vessels and nerves, the foot, as I have before re- 
marked : there is, however, an addition of heat to be detected 
about the joint, which is more particularly observable when the 
disease exists in one joint only, by comparison with its opposite. 
Also, from the small quantity of cellular membrane, and the slight 
vascularity of the parts, but little if any swelling is present; and 
it is not until the disease has existed for some time that enlarge- 
ment shews itself, and this not always: when it does, it arises 
from the deposit of lymph, the precursor of ossific deposit. The 
only form in which swelling occurs, I believe to be, where there is 
inflammation of the synovial membrane. 
When the carpal bones are united by ossific matter, the liga- 
ment becoming useless, is consequently absorbed, as we find is 
the case in other component parts of the animal body ; and further, 
when such consolidation of the minor joints has taken place, the 
lateral articular surfaces become in like manner useless, and the 
synovial membrane and articular cartilages are also replaced 
by bone ; for we must consider, the disease having proceeded 
only so far as the consolidation of some of the carpal joints, that it 
is a process of Nature to make stronger that which has been found 
to be a weak part. 
Should the injury be repeated after this, the most favourable 
termination, or extend to other and more important articulations, 
we find that the result is ulcerative absorption, ending in caries of 
the body of the bone itself ; and this arises from the transverse not 
VOL. XVIII. 4 Y 
