ates it
gradually stretches the capsule, and pushes the patella forwards, so
that it floats. There is little pain or interference with function;
the patient is usually able to walk, but is easily tired. The amount
of fluid diminishes under rest, and increases after use of the limb.
In a certain number of cases it may be possible to recognise localised
thickening of the synovial membrane, or the presence of floating
masses of fibrin or melon-seed bodies. This is best appreciated if the
knee is alternately flexed and extended by the patient while the
surgeon grasps and compresses it with both hands. If the joint is
opened, fibrinous material, often in the form of melon-seed bodies,
may be found lining the synovial membrane.

Tuberculous hydrops is to be diagnosed from the effusion that results
from repeated sprain, from the hydrops of loose body, gonorrhoea,
arthritis deformans, Charcot's disease, and Brodie's abscess in the
adjacent bone, and from the haemarthrosis met with in bleeders.

(2) _Papillary or Nodular Tubercle of the Synovial Membrane._--This is
a condition in which there is a fringy, papillary, or polypoidal
growth from the synovial membrane. It is most often met with in adult
males. The onset and progress are gradual, and the chief complaint is
of stiffness and swelling which are worse after exertion. Sometimes
there are symptoms of loose body, such as occasional locking of the
joint, with pain and inability to extend the limb; but the locking is
easily disengaged, and the movements are at once free again. The
patient may give a history of several years' partial and intermittent
disability, with lameness and occasional locking, although he may have
been able to go about or even to continue his occupation.

There is a moderate degree of effusion into the joint, and when this
has subsided under rest it may be possible to feel ill-defined cords,
or tufts, or nodular masses, and to grasp between the fingers those in
the supra-patellar pouch. There is little wasting of muscles, and it
is exceptional to have signs of disease of the articular surfaces or
of cold abscess.

On opening the joint, there may escape fluid and loose bodies similar
to those described under hydrops, and if the finger is introduced into
the cavity, the upper pouch is felt to be occupied by fringes or
polypoidal processes derived from the synovial membrane.

The diagnosis is to be made from arthritis deformans, and in some
cases from l