Andrew Turner, 28 years of age, was ad mitted into the Richmond Hospital on the 7th of May, 1836. He had much abused his health and constitution. Five days after having been bled in the right arm to relieve the con sequences of a severe beating, a superficial dif fused redness appeared on the skin of the fore arm ; the venesection wound was swelled and inflamed ; a severe rigor occurred, followed by profuse perspiration and fever ; erratic erysipelas characterized by a faint red mottling of the skin in patches appeared ; a blush of inflammation in the form of a patch showed itself on the shoulder, but not continuous with that on the forearm; a pink patch next appeared over the right knee, then on the left arm, and afterwards on the left lower extremity ; and while this dis ease invaded the body part after part, those once occupied remained engaged as before. On the 15th May, the ninth day from his ad mission, there was observed effusion into the right knee and into the bursa which is subjacent to the crurceus muscle. Although considerable, this effusion escaped the patient's attention ; he complained of no pain, and to our enquiries always replied that he was going on " gaily." On the 18th the left knee-joint was tumefied, but not to the same extent as the right. He died on the 26th, his death being preceded by the ordinary symptoms of pneumonia, pleu ritis, &c. On the post-mortem examination the anatomical appearances of pneumonia, pleuritis, and bronchitis were seen ; there was also effu sion into the cavities of the pericardium and peritoneum. In the right knee-joint and sub cutaneous bursa, which freely communicated with it, there was a large quantity of yellowish green fluid, which seemed to be formed of the mixture of purulent matter with the synovial fluid : flakes of lymph floated in it. The syno vial lining of the subcrurceus bursa was very red, as was also that of the joint itself. The synovial membrane was elevated above the level of the cartilages by subsynovial infiltration. The ligamentum mucosum, as it is called, was very vascular. The capillary system of the semilunar cartilages was injected with minute red vessels. The left knee-joint, which had been but lately attacked, contained an inordinate quantity of synovial fluid, of a greenish-yellow hue, and of a thicker consistence and a deeper colour than natural. The synovial membrane was pale, and there was no infiltration in its subsynovial structure. The vein in which venesection had been performed was contracted in the neighbourhood of the wound, and lymph adhered to its lining membrane. Above the right elbow-joint and internal to the course of the vein, there was a small collection of matter between the skin and fascia.
Susan Brett, tat. 24, was brought into the Richmond hospital on 26th February in great distress and pain. On the 14th February she was suddenly seized with convulsions, being seven months pregnant. She was bled in the right arm and her head shaved. Two days after the operation the arm became very painful and swollen. The pain increased, and on the 21st labour-pains came on and continued during the day. In the evening she was again attacked with convulsions, and blood was drawn from the left arm. The child (her first) was not expelled until early the next morn ing; the evening of the same day she had a severe rigour, which lasted half an hour, and was succeeded by profuse perspiration; this soon went off, but she remained cold and chilly for the remainder of the night. On the following morning (23d) she was seized with what she called severe rheumatic pains in her hips and right shoulder, which left her "all sore" and completely powerless. On the 24th
the pain in the right shoulder-joint became most intense, and a severe stitch seized her in the same side, which prevented her drawing her breath. The pain in the arm also was now very severe, extending upwards from where ve nesection was originally performed. The wound was found not yet healed.
When brought to the hospital, the fifth day from her lying-in, she was in great distress and pain. Her pulse was 140, with some fulness, but still compressible. She preferred lying on her right side bent forwards, with her knees drawn up. Her respirations were fifty-two in a minute, and greatly oppressed. At each effort of inspiration the aim nasi were much dilated. Her countenance was anxious, and there was a bright circumscribed flush on each malar emi nence. For the last week she has raved con stantly at night, and has been more ill at cer tain hours of the day, very early in the morn ing, and again at half-past five, P.M. At the latter hour she was generally found perspiring copiously. Her bowels were too free. She complained of pain chiefly in the right shoulder and the lower part of the back ; also in both her knees and metacarpal joint of the index finger of the left hand. She also complained of her left hip. The right arm was swollen but not discoloured, edematous, and pitting on pressure. The original wound made for vene section was gaping, with unhealthy everted edges ; no matter exuded from it. She kept the arm in the flexed position ; to herself it felt quite powerless, and when the least movement was communicated to it, she suffered great tor ment. There was a hard line up the arm cor responding to the course of the basilic vein, and when even the slightest pressure was made in this line, she suffered pain. Immediately above the elbow-joint the skin was hard ; the subcutaneous cellular structure seemed more or less cedematous as if infiltrated with fluid ; the skin and subjacent parts seemed to be matted together and somewhat oedematous, and pres sure here also gave the patient much uneasiness. There was a suffused pink blush on the skin covering the metacarpal joint of the index finger; the joint was much swollen, and she complained of much pain in it. Her princi pal suffering was from dyspncea. An exami nation of the chest by auscultation and percus sion furnished all the evidence of extreme bronchitis in both lungs, pleuritis with inci pient pneumonia : it was also inferred that effusion had taken place into the right side of the thorax.
On the 28th February some of those deceit ful appearances of amendment not unusual in the course of acute disease discovered them selves. It was reported that she had passed a better night ; her pulse fell to 128; her respi ration was reduced to forty in the minute; but in the evening a pain, which she referred to the situation of the diaphragm, came on with great severity. Her cough was troublesome and in paroxysms ; she expressed great anxiety about herself, inquiring whether there were any hopes for her, and complained of pain in her left elbow, where, however, there was no swelling. The original wound made in the right arm for the first venesection was still open, but there was no inflammation about it. The wounds made in the left arm for two sub sequent bleedings healed perfectly. She now had pain in all her joints, particularly in the metacarpal joint of the index finger of the left hand. The shoulder-joints were swelled, and she could not bear the slightest movement of them. Her knees were very painful, chiefly the left, which was greatly swollen, but its in teguments were not discoloured. Diarrhoea was very troublesome.