any difficulty, through all parts of the joint. However, I discovered no
necrosed bone by so doing. Put a tent into this opening, and let the one
above heal up, which it did in about two weeks. This latter opening into
the joint I kept open by means of tents until the joint became anchilosed
and ceased to discharge pus. The patient made a slow and steady recovery,
and about the middle of April was able to get out doors again.

The special points of interest in this case seem to be the obscure and
insidious mode of attack; the slow progress of the inflammation, it being
rather sub-acute than acute; and the fact of its being a sequela of
pneumonia.

Prof. Gross, in his excellent work on surgery, says, "synovitis, in the
great majority of cases, arises from the effects of rheumatism, gout,
eruptive fevers, syphilis, scrofula, and the inordinate use of mercury."

Prof. Hamilton, in "Principles and Practice of Surgery," says, "synovitis
may be caused by exposure to cold, or may occur as a consequence of a
rheumatic, strumous, or syphilitic cachexia, as a gonorrhoeal
complication, as a sequela of fevers, and from many other causes, whose
relation to the disease in question may not always be easily determined."

Since there was no local injury to the knee in this case which could have
caused the disease, we must seek some other cause for it.

I have thought that its origin might be accounted for on the principle of
metastasis of morbid material. The patient had pneumonia which passed
through its several stages somewhat rapidly, resolution taking place about
the end of the second week. The symptoms of this were well marked, viz: a
chill followed by fever, cough, brick-dust sputa, delirium, pain over
lower half of right lung, which was solidified, and afterward gave the
crepitant and sub-crepitant roles. Could not the morbid material, which
entered the circulation from the re-absorption of the deposit in the
solidified lung, have been carried to the synovial membrane of the knee,
and there found a lodgment, and set up the inflammation which resulted in
the formation of so much pus? If not, Why not? Notwithstanding a tedious
illness, and an anchilosed knee, was not this result better than to have
had suppuration of the lung tissue and destruction of the whole of the
right lung, and perhaps eventually the left also? However, we are not
certain that such a result would have followed, although the patient's
general appearance at