affected both the
vessels and the internal popliteal nerve. The joint in that case was
straightened out by continuous extension by Major Lougheed, when it came
under his charge some six weeks after the primary injury, but I hear has
again relapsed, and the popliteal paralysis is not much improved.

The small tendency to formation of adhesions in uncomplicated cases
probably depended on the coagulation of a layer of blood over the whole
internal lining of the joint. This kept the synovial surfaces apart at
the lines of reflection of the membrane, and, given sufficiently active
treatment, mobility was restored before any firm union could take place.

The primary escape of synovial fluid was rarely observed, as the wounds
of the soft parts were too small and valvular to permit of it. Synovia
in some abundance, mixed with pus, sometimes escaped in considerable
quantity when infection had opened up the tracks.

Primary suppuration in any joint as a result of small and direct wounds
was very rare. I observed it only on one occasion. On the other hand, a
considerable number of cases in which secondary suppuration occurred
came under my notice. In some of these the suppuration was secondary to
comminuted fractures of the shaft of the tibia, in which the articular
extremity was implicated. These offered no special peculiarity. In
others infection of the joint was secondary to infection and suppuration
in the deep part of long oblique wound tracks, and these were of
sufficient interest to warrant the insertion of two illustrative cases.

(43) In a man wounded at Paardeberg the bullet entered the leg
to the inner side of the crest of the tibia, about 3 inches
below the tubercle; thence it coursed upwards to emerge about 2
inches above the cleft of the knee-joint on the outer side.
Regulation dressings were applied, and a week later the man
arrived at the Base, with little apparent mischief in the
knee-joint. He was placed in bed and warned against movement;
on the second day, however, he got up and walked to the
latrine. When bending his knee to sit down he was seized with
agonising pain in the joint, and had to call out for help; he
was then carried back to bed in a more or less collapsed
condition. The knee commenced to swell; there was rise of
temperature and great pain, together with extreme restlessness.
I was asked to see him two days later, and after