Bauhaus-Universität Weimar

The Cyclopaedia of Anatomy and Physiology, vol. 2: Dia-Ins
Todd, Robert Bentley
swelling that had presented the usual charac¬ 
ters of this disease in its advanced form, we 
usually notice the surface of the skin studded 
over here and there with the orifices of fistulous 
L canals ; these are found generally to have pro¬ 
ceeded by a winding course, either from the 
cavity of the elbow-joint or from the cancellous 
structure of the bones, or from both these 
sources. When a section is made of the bones 
in this advanced period of the disease, they 
will generally be found to be softened in the 
interior, and to contain a fatty or yellowish 
cheese-like matter in their cells ; when exam¬ 
ined in an earlier stage of this scrophulous 
caries, these organs are generally found to be pre- 
ternaturally red and vascular, and with much 
less proportion of earthy matter than natural, 
I so that they admit not only of being cut with a 
knife without turning its edge, but yield and 
are crushed under very slight pressure. 
We have also occasionally opportunities of 
examining the joint when the process of caries 
would appear to have been arrested and to 
have given place to a new growth of bony vege¬ 
tations around the joint; under such circum¬ 
stances, conical granulations, several lines in 
length, shoot out like stalactites around the 
trochlea of the humerus and from the olecranon 
and coronoid processes of the ulna ; the bones 
are, however, in these specimens remarkably 
light, porous, and friable. In some cases, 
however, the caries of the bone has altogether 
ceased, and a process of anchylosis has been es¬ 
tablished, and the fore-arm is flexed on the arm : 
a section through the elbow-joint longitudinally 
will in such cases frequently exhibit a com¬ 
plete continuation of the cancelli through the 
joint from the cells of the humerus to those of 
the radius and ulna. 
Rheumatism.—The elbow-joint, like all the 
other articulations, is liable to attacks of acute 
rheumatic inflammation, the external signs of 
which differ but little from those which we 
observe to attend an ordinary case of acute 
synovitis. The disease, however, seldom fixes 
itself for any time upon this or any one joint 
in particular and usually terminates favourably, 
so that opportunities seldom occur of ascer¬ 
taining by anatomical examination the effects 
of this species of inflammation in the different 
. structures of the elbow-joint. But this articu¬ 
lation is, in the adult and in those advanced in 
life, affected by a disease which, for want of a 
better name, is termed chronic rheumatism, 
the anatomical characters of which are very 
remarkable, yet they never have received 
ij= from pathologists that attention they appear 
to us to deserve. In these cases the elbow- 
joint becomes enlarged and deformed; its or¬ 
dinary movements, whether of flexion, exten¬ 
sion, or rotation, become restricted within very 
narrow limits ; and when we communicate 
I to the joint any of these motions, the patient 
I p complains of much pain, and a very remarkable 
crepitation of rough rubbing surfaces is per¬ 
ceived : a careful external examination of the 
joint will in such circumstances enable us to 
J detect foreign bodies in the articulation. Some 
of them are small, but others occasionally are 
met with of a very large size, and can easily be 
felt through the integuments. Sometimes the 
synovial membrane of the joint itself is much 
distended with fluid, and the bursa of the ole¬ 
cranon is likewise affected, in which small fo¬ 
reign bodies are also to be detected : sometimes, 
however, there would appear to exist in the in¬ 
terior of the joint even less synovia than natural. 
The muscles of the arm and fore-arm for want of 
use are more or less wasted and atrophied. As 
the external appearances vary, so also do we find 
the anatomical characters of the disease to pre¬ 
sent varieties, some of which deserve notice. 
We have found the most general abnormal ap¬ 
pearance to be that the cartilages are removed 
from the heads of the bones which are greatly 
enlarged, and that these articular surfaces are 
covered by a smooth porcelain-like deposit, 
and after a time attain the polish and smooth¬ 
ness of ivory : the trochlea of the humerus, 
also, and corresponding surface of the great 
sigmoid cavity of the ulna are also marked 
with narrow parallel sulci or grooves in the di¬ 
rection of flexion and extension. In these cases 
the radio-humeral joint is likewise affected, the 
head of the radius becomes greatly enlarged, 
and it assumes quite a globular form, while the 
anterior and outer part of the lower extremity 
of the humerus will have its capitulum or con¬ 
vex head not only removed, but here the 
humerus will be found to be even excavated to 
receive the head of the radius, and to accom¬ 
modate itself to the new form it has acquired 
from disease. In many cases where the radius 
had become thus enlarged and of a globular 
form, the writer has found the cartilage removed 
altogether and its place occupied by an ivory¬ 
like enamel. In two examples he has seen a 
depression or dimple in this rounded head of 
the radius, similar to what naturally exists in 
the head of the femur, and in these two cases, 
strange to relate, a distinct bundle of ligament¬ 
ous fibres analogous to a round ligament passed 
from the dimple or depression alluded to, con¬ 
necting this head of the radius to the back 
part of the sigmoid cavity of the ulna. In 
some few cases, when the external signs of this 
chronic disease in the elbow-joint were present, 
we have found the bones of this articulation 
enlarged, hard, and presenting a rough porous 
appearance, while the cartilage was entirely 
removed; but in these specimens no ivory 
deposit was formed. These were cases in 
which the same disease existed locally, and the 
same disposition prevailed in the constitution ; 
but from the bones having been kept in a state 
of quietude, the rough surfaces of the articular 
extremities had not been smoothed by the 
effects of friction, nor an ivory-like enamel 
formed. We believe that in such cases, were 
life prolonged, anchyloses would be established : 
in other instances the head of the radius has 
not been found enlarged as above described 
but otherwise altered from its natural form. 
The superior articular extremity of this bone 
has been found excavated from before back¬ 
wards, its outline not being circular nor exactly 
oval but ovoidal, accurately representing on a 
small scale the glenoid cavity of the scapula.


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