has been most successfully injected by Mr. Shekleton, teaches
the nature of the organic changes in the joint. The synovial
membrane is the structure almost exclusively implicated: the
interior of the capsule is lined with a pulpy, highly organized
coating of lymph: wherever it adheres loosely to the heads
of the bones, it presents the same appearance ; and even on
the cartilages of the femur, but more particularly on that of
the patella, the same inroads of the morbid alteration have
been made. A comparatively small part of the white cartilages
of the joint remains free from this vascular coating, and
even parts so covered admit, by the removal of this new texture,
(as shown by sections in the preparation), of being exposed,
sound and uninjured. Purulent matter existed in the
cavity of the joint. The disease had not extended to the cartilaginous
or osseous structures.—Richard Carmichael, Esq.
E. b. 801. Chronic synovitis, or white swelling of the left
knee of a girl, set. eight, removed with success by Mr. Carmichael.
The entire surface of the synovial membrane is
greatly thickened and pulpy, and, as shown by injection, vascular
: the central parts of the cartilages alone remain uncovered
by this new texture. The fore-part of the femur,
above the condyles, is stripped of its periosteum: there is an
unusual thickness of the adipose substance about the joint: pus
lay in the interior; some fistuke opening laterally show the
apertures through which it had, during life, escaped.—R. Carmichael,,
Esq.
E. h. 802. Left knee-joint of a middle-aged woman, the
seat of long continued, chronic inflammation (injected). The
synovial cavity forms, anteriorly, a great bag extending up the
fore-part of the thigh, under the extensor muscles, and is
highly thickened and pulpy : the outer cartilage of the tibia
has been absorbed ; the inner one is in progress of exfoliation :
there is a central diseased spot on the patella: the cartilages
of the femur, except where encroached upon by tho hypertrophied
synovial membrane, are otherwise healthy. The bones
are all sound, but the ligaments are attenuated and relaxed.
—Idem.
E. b. 803. White swelling of the knee-joint in an advanced
stage. The cartilage has completely disappeared from the
head of the tibia, and the corresponding surface of the femoral
condyles; that on the fore-part of the latter is still entire and
covered with thickened patches of synovial membrane. The
denuded bone is coated over by a yellowish substance like
lymph, which is, however, readily removed. The fibro-carti-
lages have been destroyed. Three large abscesses communicate
with the joint, one runs for several inches up the front
of the femur; another, on its internal side, follows the same
direction; and a third is situated in the popliteal space ; their
walls are thick, and quite gristly in texture : their lining
membrane, which, in the recent state, was perfectly black,
has admitted injection pretty freely.
Removed from a boy set. fourteen. The disease had existed
for several years; and the consequent irritation had worn the
patient to a skeleton. After operation recovery was rapid and
complete.—Dr. Houston.
E. b. 804. Right knee-joint of an adult man, amputated by
Mr. Porter, for white swelling (injected). Profuse suppuration
and hectic rendered the operation necessary, but nevertheless
the joint is in a state far advanced towards anchylosis :
the cartilages have been removed, and the surfaces of the
bones and capsule are covered with a thick layer of organized
lymph, which has formed numerous adhesions in different
parts of the joint. There is considerable tumefaction arising
mainly from super-abundant adeps accumulated all around.—
Prof. Porter.
E. b. 805. Left knee-joint in an advanced state of white
swelling. Every part with which the synovial membrane had
connection is changed, and the membrane itself, as such, no