Although,  as  has  already  been  stated,  it  is  very  undesirable  to
practice  forcible  extension  whilst  inflammatory  action  is  still  going  on
in  the  joint,  yet  cases  do  occasionally  occur,  in  which  it  may  be  necessary
to  do  so,  in  order  to  correct  a  faulty  position  into  which  the  limb  has
&llen,  and  which,  if  allowed  to  continue,  might  lead  to  the  most  inve-
terate forms  of  anchylosis.  The  following  case  illustrates  the  pro-
priety of  the  forcible  extension,  even  in  acute  disease  of  a  joint.
Ccue  7. — A  woman  twenty-two  years  of  age,  was  under  the  care  of
Dr.  Qarrod,  with  very  acute  rheumatic  arthritis  of  the  left  knee.
The  joint  was  so  exquisitely  tender  that  she  would  not  allow  it  to  be


188  SUBGE&T.
touched,  but  screamed  loudly  even  when  a  hand  was  brought  near  it*
Notwithstanding  the  employment  of  very  active  treatment,  general
and  local,  the  inflammation  continued,  and  the  joint  became  firmly
contracted  at  right  angles.  I  was  now  requested  to  see  her,  in  con-
sultation with  Dr.  Garrod,  when  we  agreed  that  it  would  be  necessary,
in  order  to  prevent  faulty  anchylosis,  to  extend  the  limb  under  chloro-
from.  This  was  done,  and  lateral  leather  splints  were  applied  with-
out any  increase  in  the  inflammation.  This  was  eventually  subdued
by  repeated  leeching  and  the  steady  exhibition  of  mercurials;  and
although  the  ligaments  became  elongated, 'and  admitted  of  very  con-
siderable looseness  of  the  joint,  she  made  a  good  recovery,  with  a
useful  limb.
