11.-' BAKERS CYSTS ', AND BAKER'S TRACHEOTOMY TUBES.
MR. MORRANT BAKER'S paper "On the Formation of Synovial Cysts in the Leg in
Connection with Disease of the Knee-joint " lies buried in the thirteenth volume of the St. Bartholomew's Hospital Reports, 1877, pp. 245-261, " the family mausoleum " as the Kcports were once wittily called by Sir Thomas Smith, the editor, looking to the close body from which they emanated and the very limited circulation they attained.
Mr. Baker states that his " attention was first drawn to the diseased condition which forms the subject of the present paper by the following case which was under the care a t different times of my colleagues, Mr. Callender and Mr. Marsh, and of myself.
" For the notes of the case I am indebted to the Records of the Surgical Registrar, Mr. Butlin.
"LARGE CYST IN THE CALF OF THE LEG-OSTEO-ARTHRITIS OF KNEE-JOINT-AMPUTATION.
" A woman (M. S.), 38 years old, was admitted into St. Bartholomew's Hospital, under the care of Mr. Howard Marsh, July 22, 1873, with a large swelling in the calf of the right leg. The right leg was about twice as large as the left, from just above the knee to the ankle. There was slight cedema, and the superficial veins looked tortuous and dilated. There was no great pain or tenderness, and no hardness or swelling could be felt in the track of the popliteal vein. The swelling was generally uniform, but especially marked in the calf, where deep-seated fluctuation could be felt. A slight pulsation was also perceptible, but was apparently only transmitted. There was also some effusion in the knee-joint. The patient was thin, but otherwise in fair health, and complained only of numbness and very slight pain in the leg.
" The history given by the patient was that five months ago the right leg began to swell, and had continued since slowly increasing. She thinks that, as she stooped one day, something cracked in the knee, and from that time it began to swell. She has had swelling of the leg after each confinement.
" At a consultation which was held on the case, it was generally agreed that there was a quantity of fluid, perhaps pus, beneath the superficial calf-muscles, with probably thrombosis of the deep veins.
" A day or two after the patient's admission to the Hospital, the swelling in the calf was punctured by Mr. Marsh with a very fine trocar, and several ounces of fluid were drawn off, leaving behind a considerable amount of thickening. Much to the surprise of those present, the fluid was not purulent, but apparently cystic. It was translucent, pale red, viscid, slightly turbid, and alkaline. It contained a large amount of chlorides, and was almost solidified by heat and nitric acid. Microscopic examination failed to detect more than the presence of blood-corpuscles ; there were no pus-cells.
The measurement of the right calf is 13g in. : that of the left, 9% in. There is no enlargement of the femoral or inguinal glands. The swelling and thickening of the leg seems to be chiefly in the upper part of " July 28.-The fluid has apparently collected again.