On a post-mortem examination the kidneys were found much enlarged and friable, with some purpuric spots (petechim hxmorrhagicw) on their surface. The spleen was very small and of a healthy consistence. On opening the bursa beneath the rectus and vasti, it was found to be distended with synovial fluid of the ordinary character; no communication existed between this bursa and the knee-joint. When the proper synovial membrane of the joint itself was opened, the quantity of synovial fluid was found to be very scanty. The semi lunar cartilages were normal, but the articular cartilages which invest the tibia and femur were of a yellowish hue, and here and there appeared softer than natural. In one spot the cartilage covering the convexity of the internal condyle of the femur was superficially removed for the size of a sixpence. To this softened, ulcerated, or abraded point the principal pain was referred, by the patient during life. There were not any loose and vascular synovial fringes hanging into the interior of the joint, but examining at the circumference of the cartilage, where it invests the external condyle of the femur, this mem brane and its subsynovial tissue were very red, vascular, and villous-looking. The outer edge of the cartilaginous covering of the femoral condyle was thin and minutely serrated, and the eye of the probe could be placed under this edge.
John Nugent, at. 19, was admitted into the Richmond Hospital, January, 1839. Be had been under treatment in the country for six months for a disease of the left knee-joint which originated in a blow on the joint from the handle of a printing-press. He fainted at the time of the accident, and the pain never ceased from that day up to this period of his admission. He was reduced a good deal in flesh. He had occasional perspirations during the night, parti cularly about the head, and starting pain shoot ing up and down the leg. He could not bear the joint to be moved but kept it semiflexed, and the limb lying on the outside. He stated that before his admission he had never been altogether confined for the complaint. There was some little swelling of the knee, which was tender on pressure. There was no swelling in the ham, nor enlargement of the inguinal glands. The calf of the leg was wasted, and the thigh also was less than the other by an inch in the measure of its circumference above the knee. He remained much in thisstate until March 14th, when he complained of suffering a constant " dead pain" across the joint below the patella ; besides this there was occasionally a throbbing sensation which was more distressing to him than any other, even than the spasmodic starting of the limb. On the 2nd of April a valvular
opening was made with caution into an abscess on the inside below the articulation; thin curdy matter came away. This gave him some relief. On the 4th another opening was made in the outside above the joint, where also the abscess showed itself : matter of a similar description came away. Previous to these punctures hav ing been made, amputation was proposed to the man as the only means of escape from this disease, but he preferred to have the abscesses opened. Fever did not follow upon this first or second operation, but subsequently it set in, and ran very high for four days, during which he perspired largely and had much pain and starting of the limb, with head-ache and anxiety of manner, and for two days he was in a con fused state bordering on delirium. Nor did the evacuation of the purulent matter prevent the enlargement of .the cavities of the abscesses connected with the diseased joint, as appears by the following report, dated May 10th, made by our clinical clerk, Dr. Bradshaw. " The abscess has ascended up the thigh, running high up the popliteal region. The hectic fever is severe; his pulse in general 120, small and compressible ; emaciation had advanced and is still advancing ; his strength is giving way under the disease, and he must soon sink if amputation be not consented to." On the 10th May the report was, " Diarrhoea still con tinues, but without abdominal pain or tender ness. The emaciation is very great. Pulse 120, small, and compressible. Tongue red, moist, and morbidly clean. The flexion of the leg on the thigh becomes every day more and more considerable, so that the angle becomes daily more acute." On the following day amputation high up was performed. The disease of the knee had much affected the cartilaginous struc tures of the joint,the absorption of which seemed to have been effected by a vascular pulpy mem brane. The parts that had suffered post were the external condyle of the femur, the inner head of the tibia, and the inner and posterior surface of the patella. Along the trochlea of the femur there existed longitudinal grooves or furrows in the cartilage, which was not removed. A highly vascular and pulpy membrane was found filling the parts wherever the cartilage had been absorbed, and this membrane could be traced insinuating itself beneath the edge of the remaining portions of the cartilage, by which means the process of absorption seemed to have been effected. In the interior of the joint there were much pus and flakes of lymph, and where the. cartilages had been removed the porous surface of the bones had been covered by soft layers of lymph of very recent formation.