The joints are often affected by rheumatic and gouty inflammation;
and there are three species of disease, tolerably distinct in their
pathological characters, generally attributed to these causes. In
one there is a deposit of chalky-looking matter, composed chiefly
of super-lithate of soda, on the articular surfaces of the synovial
membrane and cartilage, but most abundantly in the cellular tissue
outside the joint, an affection in which the cartilage is seldom
known to ulcerate. In the second, the cartilages are atrophied, as if
worn away by attrition, the articular surfaces of the bone being much
modified in shape, more or less denuded of cartilage, and remarkably
polished and hard, so as to have been compared to porcelain, as will be
described in another section. In the third, the fibrous tissue in the
neighbourhood of a joint is primarily affected, the synovial membrane
and cartilages not becoming involved till the disease is much advanced.
It is not uncommon in the elbow of middle-aged persons who have been
much exposed to the atmospherical vicissitudes, and is sometimes
attributed to the effect of mercury or syphilis. The periosteum
around the articular ends of the bones becomes swelled and painful;
the affection is very slow in its progress; abundant deposition of
adventitious bone takes place, often in short spiculæ, gradually
encroaching around the joint, which ultimately becomes involved. A good
specimen is here given. The disease was of twelve months’ duration, and
was attributable to rheumatic inflammation supervening upon sprain. The
affection involves extensively all the bones composing the articulation.
Although wounds penetrating the larger joints are attended with
danger, the synovial membranes are possessed of considerable powers of
reparation, and often heal readily after severe injuries. An occasional
result of inflammation is adhesion between the layers of the membrane,
but this is by no means so frequent as in the serous tissues. The
reparative power of cartilage is so low that the best termination that
can be expected from the ordinary forms of ulceration, is union between
the abraded surfaces. In experiments which have been made on the lower
animals, portions of cartilage which had been removed from their
joints were never reproduced, but the functions of the part were soon
restored by the cut surface becoming smooth. In like manner there is
occasionally to be seen in museums a circumscribed indentation in human
articular cartilage, as if it had been destroyed by a small ulcer in
this situation, which had cicatrized without any reproduction of the
destroyed tissue.
ON HYPERTROPHY AND ATROPHY OF THE ARTICULAR CARTILAGES, WITH EBURNATION
OF THE SURFACES OF THE BONES.
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