On the pathological basis of the treatment of joint diseases / by Henry G. Davis, M.D.

  • Davis, Henry G. (Henry Gassett), 1807-1896.
Date:
1862
Catalogue details

Licence: Public Domain Mark

Credit: On the pathological basis of the treatment of joint diseases / by Henry G. Davis, M.D. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    yond this point, death, with exfoliation of the parts pressed upon. For this is precisely the result we find in joints rendered immovable by artificial means. If this result follows from pressure in a previously healthy articulation, how much more destructive must be the process in a joint whose vitality is depressed by disease! This view renders intelligible the modus operandi by which cartila- ges and bones, in some instances, are so rapidly destroyed. This re- sult to cartilages from pressure is rendered more readily admissible when we consider the manner in which they are nourished. Cartila- ges are without blood-vessels and nerves of their own; those of the surrounding parts terminate at their surfaces; those of the synovial membrane at its junction with the edge of the cartilage; those of the bone at its point of union with the cartilage. It is not necessary for my purpose to show the precise way in which cartilage is formed, only that it is possessed of a low grade of vitality. In respect to its mode of nutrition, the cartilage resembles the cornea; and, as the effect of imperfect nutrition upon this portion of the eye has been fully estab- lished, I would direct attention, to this point to illustrate the in- fluence of like causes upon the cartilages. The justness of the com- parison will be admitted if we keep in mind the similarity of their modes of receiving their nutritive supply. In experiments instituted by physiologists upon the inferior animals, it was shown that the cor- nea was readily affected with ulceration, when they were fed upon cer- tain articles of food that did not furnish them with proper nourish- ment. I mention this fact to show how easily parts which are not supplied with blood-vessels take on the idccralive process. Iu the case of the cartilage, the cause is mechanical which interferes with nutri- tion, but the result to the parts immediately acted upon is the same, viz.: deficient or interrupted nutrition by reason of uninterrupted pressure. That this result follows, is proved by the anatomical fact that the centre of the ulceration is always at the point of greatest pressure, as revealed on dissection in the cases presently to be cited. There is yet another reason, founded upon the structure of a joint, why continued pressure with immobility should be attended with dan- ger. The cartilage being an elastic substance, and affixed to the ends of two bones whose surfaces do not precisely correspond with each other, the greatest amount of pressure must come upon the centre of those portions in contact, gradually diminishing to the circumference; in this respect they are unlike two solid bodies, where the pressure would be equal upon all the parts in contact. The difficulty that would arise from this construction of the parts in a small articulating