The Formation and Excretion of Uric Acid, Considered with Reference to Gout and Allied Diseases: Being a Thesis for the Degree of M.D. in the University of Oxford
Authors: A. Haig
Journal: BMJ (1888)

circumstance that the articulation had already been the seat of a chronic inflammation.Even with this possibility before one, it may be questioned whether simple drainage and intermittent irrigation of an acutely inflamed joint would lead not only to the recovery of the limnb, but also to the perfect restoration of the functions of the articulation.In the second case, r& crarded belo-v, the question of the influ- ence of a previous chroniic inflammation did not ccnfuse the issue.The case was a simple one of acute suppuration following injury.The patient, a stoker, a vigorouw, heulthy man, aged 23, was admitted into the London hlospital on November 7th, 1887, with acute synovitis of the riglht knee-joint.On November 1st he hald fallen and had received a violent blow upon the knee.He was disabled and was taken home.The joint did not become visibly swollen until the evening, some hours after the accident.There was no wound.The patient had never had any previous joint trouble, nor, indeed, any notable illness.When seen on admissioni the patient appeared ill, and was much worn out by pain and want of sleep.The right knee-joint was a little flexed, was extremely distended with flutid.and was the seat of great pain.The skin covering the articulation was red and cedemators, and the cedema had extended some little way beyond the joint district.The temperature was 1000 F. The case was evidently one of suppurative synovitis.The limb was fixed upon a s! r tight back splint, and the joint was opened by two lateral iucisions, each alout one inch in length; througlh the incisions escapedl mucli synovial fluid mixed with pus and flakes of lymplh.A drainiage-tube was passed tlhrough the joint under- neath the patella, and the irrigation apparatus was adjusted pre- cisely as in the case already detailed.Cold water containing a little boracic acid was allowed to run throug,h the joint witlhout intermission night or daLy for one montlh.The temperature be- came normal the day after the operation, aind never rose again above 99,.Tle patient was at once quiite easy.The tube was removed on December 8th, and was replaced by two short tubes for eitlher incision.On Decemher 17tlh all drains were left off, anid thie splint was removed.There lhad been no rise of temperature, no suppiiration, and no sign of a relapse.The wounds were now (December 17th) qtuite healed, and passive movement was comrnenced.The patient left the hospital on January 8th.In the following montlh I exhibited the patient at the Hlarveian Society.Ilis recovery had beeni complete.The patella was quite movable, and he coul(d execute a complete range of movements with the right leg; indeed, there was no appreciable difference between the right limt) and the left, except that the former pre- sented two cicatrices.The treatment advocated is exceedingly simple, and would appear to be efficacious.In my previous experience of other methods of treatment I have never seen complete restoration of fuanction to follow an acute suppuration of a large joint.