AND PARTICULARLY THE KNEE. 
273 
a ttached from its practical utility ; for, after it has been examined 
bv you in all its bearings, I shall derive the important advantage 
of learning whether I have overrated its merits. 
I shall not intrude on your time by any anatomical description 
of the knee joint. It is sufficient to observe, that it is composed 
of eight bones, forming two rows ; the upper, articulating with 
the inferior extremity of the radius, and the lower row with the 
upper extremities of the large and small metacarpal bones; and 
that it has a very extensive capsular ligament arising from the 
inferior extremity of the radius, and investing the superior 
extremities of the large and small metacarpals, and forming a 
circumscribed cavity. Within this capsule or bag is secreted a 
large quantity of synovia, to lubricate the parts and prevent fric¬ 
tion. It is a joint possessing great strength with extensive 
motion, and consequently complex in its mechanism. It may 
be desciibed as a large joint containing a number of smaller 
joints. The perforation of the capsular ligament, and consequent 
escape of this fluid from the joint, constitute the subject of the 
present inquiry ; and I take leave here to mention that the mode 
of treatment which I am about to recommend, and the intention 
of my paper, have reference only to open joints, or to such for¬ 
midable injuries as expose the interior of the joint to imminent 
danger. 
The cavity of the knee joint is liable to be opened in various 
ways : the most common is by the horse falling down, in which 
case, besides the aperture made in the capsular ligament, the 
joint suffers contusion, and the other ligaments and common 
integuments are generally much bruised and lacerated. The 
knee joint is occasionally opened by some sharp instrument in 
the form of puncture, leaving only a small aperture in the skin, 
with one equally small or less in the capsular ligament, but yet 
sufficient to allow the escape of synovia. In this latter case of 
puncture, I am perfectly satisfied as to the efficacy of the actual 
cautery judiciously applied; but the cases of difficulty, and 
which are of more frequent occurrence, are those arising from 
falling, in which there is frequently not only an aperture of con¬ 
siderable size in the capsular ligament itself, but also a large 
external wound. These are the cases which the actual cautery 
cannot sear up so nicely as our theory of its modus operandi 
would lead us to imagine. 
As no surgeon has ever yet healed a broken bone by any 
balsam or nostrum which he may have applied, but has merely 
placed the fractured ends of the bone in a certain favourable posi¬ 
tion or adaptation, and used effectual measures to continue them 
so placed, and the great architect, Nature, having been undis- 
