PREFACE.

My first observations on the diseases which are treated of in the following pages were recorded in the fortieth volume of the Medico-Chirurgical Transactions.' Further observations on the same subject were subsequently published in the Medical Times and Gazette.' And since that time, in the form of a separate treatise, they have passed through two editions.

In now offering this third edition to the public, I would ask for it as much favour as was shown to its predecessors. It has been re-written, and much new material has been added. The same views are inculcated as before, subsequent and greatly enlarged experience (embracing 114 cases) having confirmed my former statements.

GROSVENOR STREET, GROSVENOR SQUARE;

January, 1861.

DISEASES OF THE JOINTS INVOLVING

ANCHYLOSIS.

CHAPTER I.

PATHOLOGICAL OBSERVATIONS RELATIVE TO

ANCHYLOSIS.

SECTION I.

Introductory Remarks The Causes of True Anchylosis-The Causes of False Anchylosis.

*

ANCHYLOSIS is that condition of a joint in which adhesions have formed, or new material has been deposited within or external to the synovial membrane, and through which motion is in part or wholly lost. This difference, namely, complete or partial loss of

* άykúλwois, incurvatio, from άykúλoç, uncus, curvus; whence is derived angulus; hence the English words, angle, angular. The etymology of this term, anchylosis, does not justify the sense in which it is at present employed. Formerly, it signified a contracted joint. Thus, "Contractos articulos, quas ȧykúλaç, Græci nominant."

Celsus says,

-Lib. v.

1

motion, has given rise to distinct terms, which imply more or less the conditions of the parts involved in the disease. Thus, anchylosis is said to be true or false true anchylosis, or synostosis being bony union of the articular surfaces, the soft structures in the interior of the joint and the cartilaginous coverings of the extremities of the bones having been removed; while false anchylosis is occasioned by membranous or fibrous adhesions within or around a joint, and which interfere more or less with freedom of motion. Muscular contraction alone, resulting from fracture for instance, may occasion entire loss of motion. This is very rare, however, and quite exceptional; vide p. 26. Muscular contraction, impeding the motion of the joint, as it is ordinarily seen, and without adhesions, is not understood as anchylosis. True, complete, or bony anchylosis, or synostosis, then, signifies complete loss of motion in the affected joint; and false, partial, or fibrous anchylosis, implies that motion is impaired, but not wholly lost.

Further, anchylosis, whether true or false, may be straight or angular, and simple or compound, i. e. complicated with dislocation. This complication with partial or complete dislocation is not rare: it occurs especially after the formation of abscess. Some authors have included unreduced dislocations in their consi