On the 2d of March profuse perspiration broke out over the whole body, and (edema of the feet came on. The next morning her pulse was 128; respiration was jerking and very much hurried ; and her countenance be trayed great internal distress. She had raved all night. There was complete orthopncea, an the swelling of the knees increased. She die at four o'clock.
On an examination of the body twenty-two hours after death, the shoulder-joints were found to contain a viscid greenish imperfectly formed pus. Matter of the same appearance, but less viscid, was met with on cutting down to the right shoulder-joint among the muscles external to it. The cartilages in both these , articulations had lost their colour and seemed thinner than natural, but were not ulcerated. The elbow-joints were in a normal condition. The joint of the index finger contained a thin greyish coloured matter, which was not con fined to the joint, being also found in the mus cles external to it. The cartilages on the head of the metacarpal bone and corresponding sur face of the index finger were much ulcerated and partially removed. The knee-joints con tained a large quantity of a viscid greenish matter like lime-water and oil. Behind the right knee-joint, and extending down to the gastrocnemii muscles, matter of somewhat a similar character, except that no synovial fluid was mixed with it, occupied the interstices of the muscles and the cellular tissue of the lower part of the poplin:cal region. The hip-joint did not contain any matter.
The basilic vein of the right arm was plugged up with a dense coagulum, which closely ad hered to its internal tunic, and was not easily separable from it. There was no pus in the vein; its exterior presented an unusual red co lour.
On opening the cavity of the chest a quan tity of serum escaped. There was a great quantity of a very yellow lymph effused on the surface of the pleura of both lungs, principally the right. In many places it was very thick, rough, and consistent. On the diaphragm and in the right side of the chest the lymph was soft, of a greenish colour, being in shreds easily removed, and leaving the subjacent mem brane highly vascular. There were also evi dences of interlobular pleuritic having existed : all division into lobes had been effaced. The lungs presented specimens of pneumonia in its three stages. A very small portion of the apex of the left lung alone seemed healthy, but even here the bronchial membrane was en gaged and presented evidences of bronchitis having existed. In the substance of the lungs there were also found small abscesses present ing near their surface like little gangrenous abscesses surrounded by ecchymosed red spots ; these contained some grumous dark-coloured fluid, which, however, was inodorous. In others
was found an ill-digested purulent matter ; and leading to one of these disorganized portions of the right lung near its apex, the minute veins on very careful dissection were found thickened, with yellow parietes; and many of those present at the examination satisfied them selves that these minute veins contained puru lent matter. The heart and pericardium were natural. The most careful examination could discover nothing abnormal in the uterus. The large intestines throughout presented numerous ulcerations on their mucous surface; the neigh bourhood of the ileo-ccecal valve being most beset by them. The mucous membrane was in a state of hyperwmia.
The prognosis in cases of acute arthritis genu is in general very unfavourable except when the disease accompanies what has been usually termed rheumatic fever. In this case the syno vial system of all the articulations is visited in succession, until the inflammatory disease ex hausts itself as it were in three or four weeks, often leaving no trace behind. It is, however, well known to medical men that in the course of these fevers fatal metastasis may occur from the synovial membrane of the knee or other joint to the pericardium or peritoneum.* In some few cases, after the general rheumatic fever and acute specific arthritis had subsided, we have known the chronic rheumatism, or nodosity of the joints, to set in, remaining permanently to interrupt the patient's health. Not long ago there was a young woman in the Richmond Hospital, under the care of Dr. Hutton, having acute arthritis of the right knee-joint„#'vhich had remained after a severe attack of, general rheumatic fever. All the joints in succession had been visited by in flammation. The fever, with its debilitating accompaniments, profuse perspirations, &c. subsided, but the local symptoms of acute arthritis of the right knee-joint continued, and increased even to suppuration, nor did ampu tation of the limb save the patient's life. These unfavourable results of acute arthritis, of the rheumatic form, may be considered as excep tions. In general the form of inflammation of the joints, commonly called rheumatic fever, terminates favourably; on the contrary, in cases where the knee-joints and other articulations are engaged during an attack of diffuse inflam mation, puerperal arthritis, or phlebitis, the prognosis is most unfavourable, the disease in all these cases being generally fatal whether the joints be implicated or not.