Two Singular Cases of Diseased Knee-Joints Successfully Treated. The First by Topical Applications; The Second by Operation. By Mr. Joseph Warner, F. R. S. Surgeon to Guy's-Hospital

Two Singular Cases of Diseased Knee-Joints Successfully Treated. The First by TopicalApplications; The Second by Operation. By Mr. Joseph Warner, F. R. S. Surgeon to Guy's-HospitalAuthor(s): Joseph WarnerSource: Philosophical Transactions (1683-1775), Vol. 49 (1755 - 1756), pp. 452-458Published by: The Royal SocietyStable URL: http://www.jstor.org/stable/104955 .

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[ 451 3 tefens,gernzinib7vs arbor74m gemtnas fruSifernas refbresstib<

-l have had an opportunity 12tely of examining tllis curious, flethy, coral-like figure in the micro- fcope, and.firld, that all the interItices betwcen the Ilars are fill d 5vith eggs of different fises, each ad- hering by one end to a very fine capillary filament. The fmallett eggs are giobtllar, and as they advance in i1ze, change to an oval figure; from thence they aliume the nlape of one ofthe radii of the Rars.

In feveral of thefe ilars I have obSetved a fmaller radius, as it were, endeavourilzg to get into the cir- cle ; and notwithllanding thcir feeming conneEtion in the center as one animal, I believe l Shall foon be able to Ihew you, in a drawing from the microScope that each radius is a diitindc animal by itSelf. I am,

Dear Sir, Lawsence-lane, Jan. 22, Your nzoR affedcionate Friend,

I 756.

John Ellis.

EXII. 7>wo J*ngglar Cafes of diJ<eaJ ed KreeS 30irts J vccegsfully treated. 7Se firJ? by topical Applications; the /*ecoxd by Ope- ration. By Mr. JoSeph Warner, F. R. S. Surgeor to Guy's-Hofpital.

Read Jan. 22, SeaSes of the larger joints of the 1756* jJ extremitieshavealwaysbeenlook'd

upon by furgeons of the greateR eminence in their pro

[ 451 3 tefens,gernzinib7vs arbor74m gemtnas fruSifernas refbresstib<

-l have had an opportunity 12tely of examining tllis curious, flethy, coral-like figure in the micro- fcope, and.firld, that all the interItices betwcen the Ilars are fill d 5vith eggs of different fises, each ad- hering by one end to a very fine capillary filament. The fmallett eggs are giobtllar, and as they advance in i1ze, change to an oval figure; from thence they aliume the nlape of one ofthe radii of the Rars.

In feveral of thefe ilars I have obSetved a fmaller radius, as it were, endeavourilzg to get into the cir- cle ; and notwithllanding thcir feeming conneEtion in the center as one animal, I believe l Shall foon be able to Ihew you, in a drawing from the microScope that each radius is a diitindc animal by itSelf. I am,

Dear Sir, Lawsence-lane, Jan. 22, Your nzoR affedcionate Friend,

I 756.

John Ellis.

EXII. 7>wo J*ngglar Cafes of diJ<eaJ ed KreeS 30irts J vccegsfully treated. 7Se firJ? by topical Applications; the /*ecoxd by Ope- ration. By Mr. JoSeph Warner, F. R. S. Surgeor to Guy's-Hofpital.

Read Jan. 22, SeaSes of the larger joints of the 1756* jJ extremitieshavealwaysbeenlook'd

upon by furgeons of the greateR eminence in their pro



t 453 ] profeffilon, to be attended with confiderable danger to the pattent; and with the greatcI} reafon, fince they have been convinced from much experience, that tllefe maladies are too often the confequences of depraved habits of body, ariI^1llg from fcrophulous, fcorbutic, or fome other general cauSe. But tho' we are fufficiently apprized of thefe fafts, and that they too often baffle the greate{} fkill in phyfic and furgery, we are neverthelefs not to infer from hence, that every diforder of this kind is attended with the like bad circumflances; f1nce it is well enough known to the experienced, that difeafes of the joints, particularly thofe of the knee, are fometimes merely local complaints, which may not only lze ailRed by furgery, but perfedily cured. Thefe Epecies of tu- mors I now hint at, are thofe, which are diIlin- gui{hed by the name of hydrops articuli, or the dropfy of the joint; of svhich there are, as I have often obServed, two different kinds. The otze, wherein the difeafe is Eltuated in the membrana adipofa, and neighbouring parts on this fide the capfular liga- ulent. The other is thatfpecies of difeafe,wherein the fluid is contained within the capfular ligament, be- twixt the extremities of the thigh-bone, alld the largeR bone of the leg. The firIt fpecies of tumor nlay be diRinguithed from the fecond by the touch ; from the appearance ofthe tumor of the fir kind, which is pale and uniform; from a want of fluecu- ation; and frotn the little or no degree of pain attending it Tlle repeated uSe, for fome weeks, of £:molliellt fotnentations, mercurial fridions, and gesl- tle purges, has been often kllotvn to remove this diforder. At orller times it has been found, that

vOL. 49. N n n thefie



[ 454 ] thefe applications have had little or Ilo effeEt, but that the difeafe has given way to, and been totally removed by the ufie of perpWtLlal bliRers to the part affeEted; which {hould, in moll inRances, be continued for feveral weelis. At otller times, I have known the PiXeleon Indicum, ill Engtilh called the 13arbadoes tar, to have fO good an cff.-e. by being ap- plied every day to the joint, for I:orne weeks, even after every other remedy had failed, as to cure fucil a diforde1 of the knee joint, as had hitherto been judged defperate: in whicll cafe there plainly appeared to be an enlargement of the bones, as well as 2 very conE1derable one of the integtlments, and of the tendinous and ligamentous parts, but without any apparent inflammation. Irl this inilance there was no extravafated fluid could be diScoverd; however) there was an immobility of the joint, and a conI1- derable contraaion of the hamItrings. - The pain was extravagantly great, which the patient defcribed as fhooting thro the ligaments ofthe joint, the knee- pan, the extremities of the thigh-bone, and thofe of the leg. He had a fevere fvmptomatic fever, which had been of tnany weeks continuance, and was be- come greatly emaciated thereby. The reafon for tlay giving fo particular a relation of the circumIlances attending this fad proceeds from my deElre of re- ¢commending a tryal of tlae fame remedy, in the like cafes; which, as far as I can judge from my own experience) may always be fafely done, where there is no degree of inflammation already formed upon the integuments. And I am fartller induced to comm;uIai- cate a thort hiRory of the cafe to this Society, as it is an application I never faw made uSe of before, in the

11. ic



[ 455 ] like caSeX tho' the ufe of it has not been uncommon in old fpl ains of the joints; wherein it has oftentimes been fotlnd to be of iingular fervice) even when otller remedies have been ineffidrually tried.

The fecond fpecies of hydrops articuli, or that where inthe extravafated fluidiscontainedwithin the capfular ligament,maybe ditinguiShed from thefirll,fromits deep fituation; from the fludruation which is felt UpOIl

patting the knee on one fide, while the other hand is held immoveably on the oppofite f1de; from the degree of pain ariElng from tlle diltenElon, which the capfular ligament fuffers) in conIequence of its con- tents ; fLom the incapacity of bending the joint; and from the circumItance of its being attended with no general complaints of bo-dy as well as from the fud- den enlargement of the tumor; upon the increafe of which depends the degree of uneaiJlnefs in the part. This is very far from being the cafe, in that kind of difeafe called the fpinaventofa, which arifes origi- nally from the medulla and bone itEelf being difeafed; from whence proceed grievous pricking and throb bing pains, that come on previouily, in generalX to any viE1ble enlargement of the part affeded, or any difcoverable quantity of fluid depofited in the joint; the difference of which fymptoms refulting from the differentdifeafes may be learned from the fiucceed- ing caSe, wherein it was judgedneceISary to cutmore than orlce thro' the capfular ligament, in order to evacuate itst contain'd, extravafated fluid; which} contrary to the cotnmon received opinion of wounds of the ligaments being attended with certain de- Itrud:ion to the limb, {hould always be done under the like bad circumItances) in reaSonable expedtation

Nnn z of



[456 ] of remolring a complaint, which totally difables the patient, and too firequently terminates in the lofs of thz limb, vvhen negleEted. And I am more particularly inclined to recommend this praftice, as I an convinced, that this difeafe is out of the reach offilch applications, as are of fervice in other difeafes of thefe pares, whofe fituation is more fuperfi>ial; that is, on this fide the ligament, in which is contairJed the fynovia.

William t)rury, aged 28, by bufinefs a porter, wasput under my care, on tlle 5th of Septembet, 17S4) for a diforder in his knee. Upon enquiry, itappeared greatly fwelled, was attended snrith ex- ceIllve pain, which was continual: there svas not the leaS degree of inflatnmation upon the sntegu ments; the patient was incapable of bending his knee in the leaR degree, or of fietting his fout to the ground. He could get no reft. The diforder arofc without any accountable cauSe, and had been only of three weeks Itanding. Upon placing one hand on the olltfide of the knee, and by pattirlg with the othex on the infide, it was eafy to difcover a flllEuation; on which account I judged it advifeable to make an opening into the tumor, which I did by incifiorl on the upper and infide of the knee-pan, as this was the moR prominent part; upon which, a thick, gela- tirsous lquid, deeply tinged with blood, was difcharged in a full flcream to the quantity of fourteen ounces. Af- ter the whole of it was evacuated, I paflRed a probe thro' the wound, whtch went under the knee-pan : the wound was fuperficially dreEs d with lint, and the whole of the knee was covered with a pultice of Rrong beer-grounds and oatmeal The patient complain'd

Qf

6



[457 ] of conElderabIe pain for about fvur hours aftersrzardss when lle grew eafy, and fo continued till the fecoond day after the operation, when the knee became a good deal painful: there weas no difcharge f.-otll the- wound. Upon enquiry I found he had not:^ been at llool for three days, which occatione:l the adtni_ niRring of a clyRer, by which flools were procured? and the pain became confiderably abated. 8I1 tt third day from the operation there appeared a colfi- derable diScharge, and his knee was quite eafy, which continued fo till the fixth day, when the dit: charge was much abated. The pain returrled and con; tinued till the eighth day, when the difcharge re- turned again, and the pain was removed. ObiServ ing from this time, that the diScharge enc-earred, and fo continued eafy till the eleventh day, which proceeded altogether frotn within the joint, I dilated the wound, that the matter might have a more ready iffiue This anfwered my expeftation, and the patient continued eafy till the fifteerlth day, when he complained of a return of pain. Upon examination, I perceived the outf1de of tlle knee was fwelled, and upon preSure I diScovered a fluduation, vvhic1 irlduced me to make an ilzcifion thro' the iIlttgll-

ments and capfular ligamentX on this fide, which, I diScovered, by the uCe of the probe, that paid uncier the knee-pan, to have a comtuanica.tion with the wound on the inf1de. From this time ehe patient wentonverywell, withoutanyfarther complaints;-

and in about tuselve weeks from the fi}flc operatic)n,

he became perfeEtly well, and Rill conXinues fos without aIly other complaint than that of a fnzall

degrez



[ 458 ] eIfSgree of lliffizeSs in tlle oint, as I have srery lately lIaCt a.n opporfun.ty of informing myfelE.

- Durirlg the whole time of the cure, I made uSe of emollient fotuentations, dreSed the wounds fuperficially, and continued the pultice of ltrong-beer grounds alld oatmeal) which were the only me thods take1l in furgery for his relief.

Hattoll*Gardell,

3an.3r, I755.

LXIII ExtraSofaLetterfiomMr. Wil liamPye, datedManilla, 02. I[t 1754, ro his Brother ir Lorsdon. Comtnvsicated to Mr. Ben;. Wilfon) F. R. S. dy the Ho. Mr. Barringtorl.

Read Ja6' 29 lr Wlll now give you fome defcription of j thls place. Manilla iS one of the

largeR of tlae Philippine iflands, and the city is nztlch larger than Oxford, and has two univerE1ties ill it, a1ld is inhabited only by Spaniards. The houEes are large? and built very llrong ; the ground-floor is fl;one; the walls of a prodigious th ckneli; all abovc is ssroods and fo contrived, t1aat every piece of timber has a connedion with each other, all over the houSe: tiacy are let into one another, and joined together, tlat tlle earthquakes, wldich are very telrible and freauent, may not thronv them dovrrn. rthe con- vents are likev7ife very flrong and handSome. The fubui bs are very extenElve) and well inhabited.

In

[ 458 ] eIfSgree of lliffizeSs in tlle oint, as I have srery lately lIaCt a.n opporfun.ty of informing myfelE.

- Durirlg the whole time of the cure, I made uSe of emollient fotuentations, dreSed the wounds fuperficially, and continued the pultice of ltrong-beer grounds alld oatmeal) which were the only me thods take1l in furgery for his relief.

Hattoll*Gardell,

3an.3r, I755.

LXIII ExtraSofaLetterfiomMr. Wil liamPye, datedManilla, 02. I[t 1754, ro his Brother ir Lorsdon. Comtnvsicated to Mr. Ben;. Wilfon) F. R. S. dy the Ho. Mr. Barringtorl.

Read Ja6' 29 lr Wlll now give you fome defcription of j thls place. Manilla iS one of the

largeR of tlae Philippine iflands, and the city is nztlch larger than Oxford, and has two univerE1ties ill it, a1ld is inhabited only by Spaniards. The houEes are large? and built very llrong ; the ground-floor is fl;one; the walls of a prodigious th ckneli; all abovc is ssroods and fo contrived, t1aat every piece of timber has a connedion with each other, all over the houSe: tiacy are let into one another, and joined together, tlat tlle earthquakes, wldich are very telrible and freauent, may not thronv them dovrrn. rthe con- vents are likev7ife very flrong and handSome. The fubui bs are very extenElve) and well inhabited.

In



Documents

Two Singular Cases of Diseased Knee-Joints Successfully Treated. The First by Topical Applications; The Second by Operation. By Mr. Joseph Warner, F. R. S. Surgeon to Guy's-Hospital