Affections of the membranes, ligaments, and bones, often occur in
persons of weak constitutions, and proceed very gradually. They have
been all classed under the general term of white swelling. They most
frequently present themselves without any assignable cause, or are
attributed to the slightest injuries. The disease generally commences
in the cancellated texture of the bones: these are soft and light, and
contain in their cells a quantity of caseous or tubercular matter. The
softness is attributable to an interstitial atrophy of the bony tissue,
as well as to an alteration in the proportion of its constituents; the
animal matter being in excess, with a corresponding deficiency of the
phosphate of lime. There is an increased vascularity of the medullary
membrane, and the cancellated texture contains thin brownish-looking
fluid instead of marrow. In cases of disease which has commenced
in the cancellated texture, there is hardly any pain at first, and
the progress of the disease is remarkably insidious. When the lower
extremity is affected, the child is observed to limp; the limb wastes;
it appears to be longer, partly from atrophy of the muscles, partly
from relaxation of the ligaments and effusion into the joint.
The term white-swelling, which ought to be discarded from surgery,
was at one time made to include all the different affections to which
joints are liable in weak constitutions—thickening of the parts,
with an external colourless swelling—collections of matter about
articulations, with or without an external aperture—effusion of fluids
into the cavities of joints, or into the bursæ—destruction of cartilage
by ulceration, or in consequence of portions becoming dead—absorption,
ulceration, caries, or intractable ulceration of the bone adjoining the
articulation.
Those under twenty years of age are most liable to chronic affections
of the joints, and they occur very frequently in children. Great
anxiety is often shown by friends of patients to account for chronic
disease of a joint, so as to save their whole generation from the
imputation of being tainted with scrofula. It is attributed, sometimes
correctly enough, to some injury perhaps trifling; to a sprain, or
twist, or squeeze from a tight shoe, or to a bruise from falling; and
it is no doubt true, that young or old people of the most healthy
constitutions, if thrown out of health from one cause, will present
all the appearances of scrofula, and become affected with chronic
diseases of the mucous membranes, glands, joints, or bones, from very
slight existing causes.
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