| OCR Text |
Show DISEASE or THE KNEE JOINT. 103 DISEASE OF THE KNEE JOINT. ops-sun, ed. To save the pressure on the joint the patient allows the toes only to touch the ground, the knee is consequently . . wry-1;...- .‘377‘"‘ "A I CHAPTER v1. DISEASE 01" THE KNEE JOINT. 1 "slow Mum, ‘l . l ,f. \. l 62 vl‘ 4 OPERATIONS are at least proposed to be performed on the knee joint, which make it necessary to take a general review of the diseases of the knee. Why we should take this joint in particular after the hip joint, is sufficiently evident. It is the largest joint; it carries the Whole weight of the body and limbs; it is weak in the structure of the bones, and consequently complicated in its ligaments. The ligaments and tendons about joints are very subject to disease, and here they are exposed, being only covered by the integuments, whilst in the other larger joints they are protected by large muscles. IN WHITE SWELLING, an uneasinessand weakness in the joint are first observed ; the pain increasing, it is observed to be fixed ; and now on each side of the tendon of the patella there is a soft, puffy tumefaction. By some supposed strain, or in consequence of damp, or cold, there is an increase of pain and swelling; in proportion to the increase of pain is the swelling becoming more general. When the pain increases, the constitutional irritation commences, and is marked by an accession of fever in the evening. s regular and uniform, covering and concealing the natural projections of the heads of the bones. The disease is yet in the ligaments and cellular membrane around the joint, and perhaps not yet in the cartilages of the joint. But now a very peculiar appearance is produv ‘ _ r»~‘l'"7'*i‘ ‘vaajmeww ,. 7..-... . The swelling of the knee in this disease has something peculiar in it; the skin is smooth and clear, the tumour 'bent, and the inflammation which surrounds the hamstrings produces a permanent stiffness, the leg and thigh waste from inaction, so that altogether the swelling of the knee appears more remarkable than it is in fact. The disease proceeding in its course, and the hectic fever being established, the strength and spirits fail; the cartilages of the joint are now consuming, and about this time the symptoms are aggravated by external inflammation ; the skin sometimes bursts and discharges pus, which has often no connexion with the general swelling, nor does this discharge diminish the swelling, or relieve the pain of the joint in any considerable degree. But matter is now formed around the joint, and the sinuses will sometimes admit the probe to pass in all directions. When the leg is amputated, this is the appearance which is presented on dissection. The cellular membrane around the joint is loaded with viscid fluid, which, contained in the cellular texture, resembles jelly. The ligaments have lost their natural density and lustre, and fistulous sinuses run hetwixt them and the surrounding tendons; within the joint there is lymphatic exudation, in the advanced state of the disease the cartilages are corroded, and lastly, the bone itself sufl'ers by ulceration. The disease varies much in its period. I have seen it run its course in two months, and l have seen the constitu- tion bearing up against it for years, though the disease was most distinctly marked, and the suffering almost continual. To say merely this is a scrophulous disease, is saying very little. It is a disease falling peculiarly on parts having little blood circulating in them, and which consequently possess low powers of life. It seems first to attack the liga- ments and cellular membrane, and then the cartilages. Often I have known surgeons in consultation on the pro< priety of amputating in a white swelling of the joint, give their opinion decidedly for amputation, because the bones |
