Pathological and surgical observations on the diseases of the joints

Front matter

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Chap. XII. Caries Of The Spine

Sect. I. Pathological Observations - - 300 Sect. II. Symptoms of this Disease - - 322 Sect. III. Treatment of this Disease - - 342 Sect. IV. On some Cases which are liable to be mistaken for those of Caries of the Spine - 353

Chap. XIII. On Some Diseases Of The Joints Not Included

UNDER THE FOREGOING HEADS - 373

Chap. XIV. Inflammation Of The Synovial Burs^e

Sect. I. History and Symptoms of this Disease - 388 Sect. II. Treatment of this Disease - 396 cv^

OBSERVATIONS

DISEASES OF THE JOINTS.

Introduction

The following pages contain a series of observations, which were begun many years ago, and which have been continued, not without considerable labour, up to the present period. They relate to a class of diseases which have strong claims on the attention of the surgeon ; since they are of very frequent occurrence ; are a source of serious anxiety to the patients ; and, for the most part, if neglected, proceed to an unfavourable termination. There are other circumstances also, which seem to render the morbid affection of the joints a fit subject of investigation. They have scarcely met with the attention which they merit from former pathologists. The terms, white swellings, scrofulous joints, &c, have been used without any well-defined meaning, and almost indiscriminately ; so that the same name has been frequently applied to dif-

B ferent diseases, and the same disease has been distinguished by different appellations. Confusion with respect to diagnosis always gives rise to a corresponding confusion with respect to the employment of remedies; and hence I was induced to hope, that, if it were possible to improve our pathological knowledge of the diseases to which I have alluded, this might lead, not indeed to the discovery of new methods of treatment, but to a more judicious and scientific application of those which are already known, and a consequent improvement of chirurgical practice.

The joints, like the other animal organs, are not of a simple and uniform, but of a various and complicated, structure. Although, in their advanced stages, the diseases, to which they are liable, extend to all the dissimilar parts of which they are composed, it is to be presumed that such is not the case in the beginning. We cannot doubt that here, as elsewhere, the morbid actions commence sometimes in one, and sometimes in another, texture ; and that they differ in their nature, and are variously modified, and, of course, require to be differently treated, according to the mechanical organisation, and the vital properties of the part, in which they originate.

It was under the influence of these impressions that I endeavoured to pursue my inquiries into the subject of the present treatise. Believing that nothing has contributed in a greater

INTRODUCTION. 6

degree towards the modern improvements in surgery, than the practice of investigating by dissection the changes of anatomical structure, which disease produces, I availed myself of every opportunity which occurred of making such examinations. In particular, I was anxious to do this where the morbid changes were still in an early stage, and where I had the opportunity of noting the symptoms by which the incipient disease was indicated ; and the knowledge which was thus acquired became the basis of my subsequent observations. In laying the results before the public, I cannot be otherwise than conscious, that these researches are still imperfect. But I feel assured, at the same time, that those who are engaged in the study of pathology, will make due allowance for the difficulties which belong to this most complicated of all the sciences, and will not be disposed to criticise my labours severely, because they find that there is still an ample space left for those who may be willing to engage in similar inquiries.

My earliest observations on the subject of these diseases, were recorded in three papers published in the fourth and two subsequent volumes of the Transactions of the Royal Medical and Chirurgical Society. In the course of the time which has since elapsed, a large surgical practice has enabled me to obtain a more accurate knowledge of their history than I then possessed, and has, at the same time, led me to the employment of more simple and successful methods of

B 2 treatment. I have, however, met with no reason for making any essential change in the classification of those affections of the joints which are of most frequent occurrence. Indeed, it has been to me a source of much satisfaction, that all my subsequent experience has tended to confirm the general accuracy of those pathological views which I was led to adopt formerly, and which I ventured to bring forward in the first of those papers to which I have alluded.

CHAPTER I.

INFLAMMATION OF THE SYNOVIAL MEMBRANES OF

JOINTS.