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Show 101: misc.st or run KNEE JOINT. .‘ ,.-.v. <-,'_. .c.war/ya ‘ ,x» .w ,,. -. . DISEASE or THE KNEE JOINT. were enlarged. But on dissection, there proved to be no enlargement. Mr. Russel well remarks in his treatise on this subject, that the bones are seldom diseased when they appear to be so, and that the deception proceeds from the ell‘usion that is around the joint. But the bones are actually enlarged sometimes: yet this is no cause for cutting off the limb. There is no reason for determining on an amputation but the declining of the patient's strength to a dangerous degree. I have looked on the enlargement of the bone with satisfaction, as providing for anchylosis of the joint. If it be denied altogether that the bones are enlarged, 1 ass-Ow mom i t . i fa \. ranch? a? ow"? 5-va m" s. "‘ ‘- "q! I . __‘l,7,__._._-a W§v7w‘h- it" -' '-: " «.12.: V e. v then how does it happen that a patient comes to us saying, " It is very odd that his bad leg is longer than the other, although he keeps it thus bent ;" is there any other way of accounting for this than by supposing that the bones are enlarged? The enlargement of the bones favours the cure of the disease in this manner: they do not ulcerate on the surface, but become inflamed and spongy in their whole substance; the articulating surface becomes irregular, and ill adapted for motion ; the motion of the joint is lost, the bones unite ; and there being no longer irritation from the incessant motion of the joint, the disease fortunately subsides. In white swelling, the patella is not forced up from its naa tural contact with the surfaces of the eondyles ; when pressed it is unyielding, and gives pain. "'e have to doubt the reality of there being a dropsical swelling of the joint, unless the. patella yields on pressure, or the fluctuation can be (115tinctly felt on one side of the tendon of the patella, when we strike smartly on the other side. When a patient, perhaps of a weakly constitution and pale countenance, is seized with an attack of pain in the knee, I do not. immediately think of applying leeches; but, on the contrary, foment, wrap the limb in flannel, and keep it in perfect 10:: five leeches: ‘ but not with the intention of reducing the inflammation by this means, but to prevent a great increase of action on the application of blisters to the sides of the knee joint. Repeated blisters I conceive to be absolutely necessary to remove a deep-seated disease, and I have observed the greatest difference in their effect, according as they have been applied, without previously taking a little blood or not. When there has been a tendency to inflammation, and considerable power in the part, blisters have increased the genera l action in the joint, but when the activity of the vessels was previously diminished, they seemed to have substituted the superficial inflammation for the deeper disease. A blister should be applied on one side. of the joint, the size of the palm, and as the inflammation subsides, a similar one is to be put on the other side, and thus a considerable action is to be kept up on the surrounding surface. Unless there is strong reason to suppose that there is an active inflammation in the joint, I would not recommend the common cold application of linen wet with the solution of cerussa acetata in vinegar and water. If the swelling and general inflammation of a joint have succeeded to a blow, then I would bleed freely with leeches, and apply the cold wet cloths to it; but if in a constitution not prone to active inflammation, there comesa deep fixed pain, I would rather . order occasional warm stimulating fornentations with flannel or sinapisms to be applied to the joint, and the applic ation of a stimulating plaster, as of gum ammoniac, with vinega r of squills, or the cummin seed plaster. To weakly children with diseased joints, there can be no better applications than the. latter. An inflammation of the joints (the knee joint for examp le} which has no mark of the scrophulous action, nor any thing a'oIIIstitutional in its nature, must be treated with a more :(‘5L rigorous intention of diminishing action. If the pain continues, and is fixed, not diffused over the ioint, nor has shifted to any other joint, I dread that we are "'o have a (".mlirmed white swelling. I take blood by four or them cold saturine solutions are applied to the joint, and if Leeches, and after the pulse and general fever be rising, blood must be taken freely from the arm. the patient must be purged with tln tot. ll. 3. |