immediate result of
any perforation of a joint was the development of intra-articular
effusion. This consisted of synovial fluid admixed with a varying
proportion of blood. The degree of synovitis was apt to vary with the
amount of force expended in the production of the injury; for this
reason both high velocity and irregular impact were of importance in
this relation.

The constant feature, however, depended on the effusion of blood; this
was not rapid, or, as a rule, very abundant, but tended to increase
during the first twenty-four hours. It resulted in a swelling of the
joint, which possessed some peculiar features. At first elastic and
resilient, it slowly decreased in volume with the assumption of a soft
doughy character on palpation. In the case of the knee, where readily
palpated, it very much resembled a tubercular synovial membrane, except
for its extreme regularity of surface; still more closely the condition
noted in a haemophilic knee of some duration. Absorption took place with
some rapidity, and except for slight thickening, the joints might appear
almost normal, in a period of from two to four weeks. With the
development of the effusion there was local rise in temperature of the
surface, and in a considerable number of the cases a general rise of
temperature.

This latter was sometimes very marked, as in the case of all the other
traumatic blood effusions, but not quite so regular in occurrence. It
was important, as I have seen it give rise to the suspicion of
suppuration, when tapping resulted in nothing more than the evacuation
of turbid synovia mixed with blood. Pain was rarely a prominent symptom
in consequence of the generally moderate degree of distension.

As a rule, these injuries were characterised by the small tendency to
the development of adhesions; but this in great part depended on the
care expended on their treatment. If kept too long quiet, either from
necessity when the effusion was followed by much thickening, or when the
external wound was large and so situated as to be harmfully influenced
by movement, or in the ordinary course of treatment, troublesome
stiffness, even amounting to firm anchylosis, sometimes followed. I saw
several such cases, some of the most confirmed being wounds of the
knee-joint complicated by injury to the popliteal vessels or nerves. The
latter complication I saw altogether six times, but only once with a
thoroughly bad knee, and in this case the injury had