Volume 2

The Hunterian oration, presidential addresses, and pathological and surgical writings.

  • Hawkins, Caesar Henry, 1798-1884.
Date:
1874
Catalogue details

Licence: Public Domain Mark

Credit: The Hunterian oration, presidential addresses, and pathological and surgical writings. Source: Wellcome Collection.

Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.

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    there is a similar crepitating fluid, as you see in this case, in the bursa below the ligamentum patellaj; and I presume that it arises fi-om an unusual thick- ness of the synovial secretion. It is not a disease of importance, but will often give you some trouble before all the inflammation and pain go away. This girl was readmitted, after she had only left the hospital a week, having had blisters applied in the three weeks she was previously under treatment. These had so far lessened the disease that I only applied a bandage about the knee, constantly wetted with hydro-chlorate of ammonia lotion ; and under this means, with the use of bark, the effusion has been absorbed, and the disease cured. Steel, and other remedies of this kind, are often necessary; and I may remark, that you must distinguish the crepitating synovia of these cases from the sensation of loose masses of lymph often found in bursas, and occasionally in joints ; and also from the noise produced by motion in joints in which some adhesions have formed, or in which the cartilage has become uneven and rough, when crepitation is sometimes very considerable. 3. Our next case is that of William L , 35 years of age, admitted January 8th, with inflammation of the synovial membrane of both ankle- joints, and of the left knee-joint. It appears that about a fortnight before his admission he contracted gonorrhoea ; that five days ago his left foot became swollen, painful, and red: that he took a large dose of aperient medicine with relief, but in the evening of the 5th his right foot and left knee became also inflamed. There was, on his admission, a good deal of purulent discharge from the urethra, and he also complained of sharp, shooting pains in both eyes, and there was a fluid discharge from them similar to that from the urethra. Our notes inform us further, that three years' ago he had gonon-hoea, followed by rheumatic affection of his joints, which lasted four months, and that he has occasionally had some pain in his joints since that time. Here, then, you have an example of a constitutional affection, gonorrhceal rheumatism, in which several joints are at once, or successively attacked, as the consequence of infection in the form of gonorrhoea, for a clear knowledge of which remarkable peculiarity of system we are indebted to Sir Benjamin Brodie, to whose work on the joints I must refer you for the details. You see that a few days after the infection his joints have become affected, and a few days after this, his eyes ; sometimes the eyes become inflamed fii-st, and the joints afterwards ; and you may see also a similar series of attacks wlien the urethra is inflamed from stricture without positive gonorrhoea. You see, moreover, from the history 1 have read to you, that he has suffered in the same way on a former occasion, and as the instances in which gonorrhoea produces such distressing effects are rare, it is obvious that the disease must depend on some peculiarity of the constitution, which, in fact, is so very strongly marked, that individuals who once exhibit it are very