537

by the time we have been round, it is fre-quently three, or sometimes later ; conse.quently I, and many others, lose our ana.

tomical lectures ; and if we regularly attendto the hour prescribed, we also lose the op-portunities which can be afforded by dis.section ; yet, before we have our admissionticket, we are to read the rules, and answer,all these I promise to observe and if we attendpunctually, we must either lounge about theWard, or chat away our time in the pupil’froom, which might be better used in study:,dly. There is no name of the disease affect-ing the patient over the bed, as at the West-minster Hospital. 3dly, The surgical stu-dents are not allowed the Hospital Pharma-copima, which is given to the physician’pupil; consequently, we are at a loss to dis-cover the composition of the medicines pre-scribed ; nay, Mr. Brodie himself is some-times forced to ask the pupils the com-

ponent parts of the medicine he wishes tcorder. Thus, Mr. Editor, his ignorance andour own is exposed, unless our credit issaved by the presence of a physician’spupil. 4thly. We have no access to the

Surgeon’s Case Books, unless through fa-vour of the House Surgeon. 5thly. Onlyphysicians’ pupils are allowed to enter theapothecary’s shop. 6thly. The best placein the theatre is allowed to the physician’spupils, instead of all being equal-especi-cially as it is for the performance of surgicaloperations. 7thly. No notices of operations,post mortem examinations, or consultations,posted up in the pupils’ room, nor are anyregular hours observed for that purpose; infact, with regard to post mortem examina-tions, they are performed at all times of theday, whether the pupils are present or not.Mily. Surgical pupils are not allowed to attendpost mortem examinations of the physicians’patients except by courtesy, instead of right;whereas, physicians’ pupils are always pre.sent at those conducted by the surgeons.I now conclude, Mr. Editor, with the hopeof seeing these abolished by your aid, and

I remain, Sir,Your obedient humble servant,

H. A. B.,A PCPIL OF ST. GEORGE’S HOSPITAL.

Saturday.P. S.-I have just perused a letter in this

day’s Number, signed H. W. D., and hopethe advice there laid down will be adoptedby our surgeons.

I am informed that the Apothecaries Acthas expired, and they have no power to

compel us to pass an examination at theirHall, as the act was only for a limited time,and they have not attempted a renewal; willyou inform me, in an answer, next Number-

H. A. B.

[The Act is still in force.-ED.]

HOSPITAL REPORTS.

HOSPITAL OF SURGERY,

Panton Square, St. James’s.

AFFECTIONS OF THE KNEE JOINT.

No diseases require a greater degree ofdiscrimination in their diagnosis and treat-ment, than those which affect the differentjoints, for almost all their symptoms may beconsidered as rather of a general characterthan as peculiar to any individual case. Itis only by a most accurate knowledge oftheir structure, considerable practical expe-rience, a minute acquaintance with the pro-gress of the complaint, and a most impartialconsideration of all its features, taken, not inpart, but as a whole, that the surgeon canbe enabled to form a correct diagnosis, orpursue a successful plan of cure. But if thisbe true of joints in general, it must applywith particular force to that of the knee,whose complicated composition and greatsusceptibility of external injury, renders itliable to a most extensive and dangerousclass of diseases. These different affectionshave not yet, in this country, been suffi-

ciently arranged or classed, nor indeed hasany thing been added to our knowledge con.cerning them since the days of the illus-trious Bichat, whose premature death pre-vented him from collecting those factswhich his comprehensive mind, had he lived,would soon have put him in possession of.The few works which have appeared in thiscountry cn this subject, are filled with mat-ter derived entirely from him, nor havetheir authors acknowledged the source fromwhich they have obtained their knowledge,nor done any justice to his hallowed name.Those who have attempted to extend hisdoctrines have fallen into error. Mr. Bro-die, by servilely copying from him, was, bymany, supposed to have advanced our know-ledge in these diseases ; but this ill-gottenfame lasted only while there existed littleintercourse between England and her Con-tinental neighbours, but thanks to the bless-ings of peace, every one has now an oppor-tunity of becoming acquainted with the realauthor, and if he has not, there is a freemedical press to point out to whom thehonour belongs.

Considering the subject of the pathologyof joints as one of the greatest importance,and one, as yet, very little understood, wehave frequently, in former Numbers, report-ed cases from this Hospital, illustrative oftheir diseases, and particularly of the af-

538

fections of the synovial membranes and car-tilages. In a late Number several wererelated of gouty and rheumatic inflamma-tion of the fonaer structure, occurring inthe knee joint and its neighbouring bnrsas.The two following cases are curious, thoughby no means uncommon, of inflammation ofthe lower bursa of the knee joint, accom-panied with increased secretion of synovia,arising from external injury :-

Catherine W., aetat. 24, a housemaid. Inthe anterior and inferior part of her leftknee, in the situation of the lower part ofthe patella and its ligaments, there is a cir-cumscribed, very prominent swelling, aboutthe size of a goose’s egg, which affords anindistinct sense of fluctuation, as if arisingfrom a thick or oily fluid; the integumentscovering it are of natural appearance, al-

though very tense. She experiences, at

present, no pain in the knee. The motionsof the joint, which in other respects is ofthe usual form, are little if at all impeded ;her general health is good.

Reports, that about three weeks ago, afterworking long on her knees in her householdaffairs, her joint became red and very pain-ful. As the inflammation subsided, she ob-served a degree of swelling, which has sincegradually increased. By the application ofblisters, the use of calomel, and avoidingevery source of irritation, the swelling hasrapidly disappeared.

Caseof the same Disease in a nioneadvanced strcge.Caroline IL, astat. 19, also a housemaid,

and much employed in washing on herknees. Has in the right knee joint, in thesame situation as in the last patient, a verylarge tense swelling, which affords a senseof fluctuation, of the same peculiar charac-ter as the last. The disease being confinedentirely to the anterior portion of the joint, iand the fluctuation being perceptible only Iover a circumscribed space. The complaintoriginated four months ago, as in the last,and has followed, in every respect, a similar iprocess, except being of longer continu-ance ; the swelling has attained nearly dou-ble the size.The treatment has been the repeated ap-

plication of blisters and the use of smalldoses of calomel, which have reduced con-siderably the bulk of the swelling, but haveas yet by no means effected the cure of thedisease. An attention to the form and si-tuation of these swellings, in conjunctionwith their history and the circumscribedsense of fluctuation, at once pointed out thenature and seat of the disease. The swel-

ling arose, it is evident, from the increasedsecretion of synovia into the bursa ; this

having no communication with the cavity ofthe joint, the fluctuation was, on that ac-count, only perceptible in one place. This

effusion is the common result of inflamma.tion of the synovial membranes.

CASE OF INFLAMMATrON AND SUPFUKATtOX

OF THE SAME BURSA.

John W., setat. 13, a patient of Mr.Brown,of Cobham. The integuments covering theright patella and its ligament are inflamed,swollen, and very painful. The swelling,which is beginning to point, affords a mostobvious sense of fluctuation. The knee

joint, in its lateral and posterior aspects, isnot altered in form. Its motions are attend.ed with so much pain, that the boy cannotbe prevailed on to stir. His general healthis much affected. Pulse 110; skin dry;frequent rigors. The disease commencedfour months ago, with pain, lieat, and swell.ing.When brought to* the Hospital from the

country, many would have supposed him tobe labouring under what is commonly calleda " white swelling."A free incision wasmade in the anterior part of the knee, so asto evacuate a large quantity of purulentmatter, and a poultice applied. The case is

going on favourably, and will in all proba-bility terminate in a permanent cure. Thesemay be contrasted with the following.

CASE OF IDIOPATHIC INFLAMMATION OF THE

SYNOVIAL, MEMBRANE OF THE KNEE-JOINT.J. P., aetat. 22. His left knee joint is

generally and equally swollen. The enlarge-ment extended up the thigh, in the situationof the upper bursa. If the finger be appliedto any part of the joint, a sense of fluctua-tion is very perceptible. He experiencessome pain, particularly during motion. I-lis

general health is in the best condition.The complaint commenced four weeks

ago, after a violent sprain (to use his ownexpression). An inflammation, attendedwith smart febrile symptoms, first occurred.This has been gradually succeeded by theswelling. Mr. Wardrop directed the fre-

quent application of leeches, and, on thesubsidence of the inflammation, the employ-ment of blisters, with low diet, rest, andthe use of mercurial purgatives. Underthese remedies, the young man has recovered rapidly, and he will soon leave theHospital cured.We shall, in a subsequent report, give an

account of some cases of arthritic inflam-mation of synovial membranes, which arealso under Air. ’;V ardrop’s care, with theview of directing the attention of the pro-fession to the powerful effects of colchicnm,in a class of complaints which yet requiremuch investigation.

During the last week, there have beenno- operations of any consequence at thisHospital.