There is heat, throbbing, pain, and swelling of the part, sometimes
redness of the surface, and great constitutional disturbance; the
symptoms and appearances, however, vary much, according to the extent
of the joint which is involved. When part of the capsule is affected,
the inflammation spreads rapidly over all the surface; the synovial
membranes resembling the serous in this respect, as well as in healthy
structure and function. Like the serous, too, they are shut sacs, are
smooth on their surface, and furnish a secretion, the synovial, for
facilitating the motion between opposing surfaces; it is, however,
somewhat more glairy than the serous. Neither, in their healthy
state, are possessed of much sensibility, nor are ligaments, tendons,
tendinous sheaths, and bursæ, which two latter textures resemble in
every respect the synovial; when inflamed, they become most exquisitely
sensible. The incited action of the bloodvessels is followed by
increased discharge, which is less glairy and albuminous, partaking
more of the serous character. When the incited action soon terminates,
and the activity of the absorbents is diminished, the fluid accumulates
within the joint, producing _Hydrops Articuli_. This accumulation of
fluid in joints may take place without being preceded by any apparent
inflammation, and may remain a long time without any visible change
of structure in the membrane. The knee is more frequently the seat of
dropsy than any other joint.
When the action is more violent, and is not actively opposed, lymph
is effused on the inner surface of the membrane, or is deposited
amongst the ligamentous and cellular tissues external to the joint,
in consequence of which, the membrane and external ligaments become
thickened, and of an almost cartilaginous consistence. Serum is
effused into the more superficial cellular tissue, filling up the
hollows around the joint, concealing the protuberances of the bones,
and producing a globular swelling. The articulating surfaces become
ulcerated, and matter forms within the capsular ligament; or the
pus is deposited exteriorly to the joint, and gradually approaches
the surface. But although ulceration is so prone to occur in the
cartilages, the synovial membranes do not readily take on this action,
unless from the progress of matter, formed within the joint, towards
the surface. The synovial lining of the bursæ and sheaths of the
tendons are extremely indisposed to ulcerate; and it may be remarked,
that, while suppuration without ulceration is common in the synovial
membranes, the cartilages, on the other hand, afford frequent instances
of ulceration without suppuration, of which more particular mention
will be made in the sequel. The cartilage is occasionally swelled and
softened where the disease has long existed.
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