Possibility of the occurrence of marked joint-lesions before the symptoms of spi nal disease manifest themselves to any great extent. Attention called to the close similarity between the joint-lesions of tabes dorsalis and those of syringo myelin; but, while the former disease ffects the lower extremities (76 per cent.), the latter confines itself to the upper. Osteomata of the tendons, mus cles, etc., are found in both diseases, but more frequently in sy-ringomyelia. If only the loeal conditions were considered, it would be difficult to differentiate the two affections. The joint-lesions may be divided into the atrophic form, which is rare, and the hypertrophie form, which is more common. Charcot (Le Prog. Med., Apr. 29, '93).
Locomothr ataxia manifests itself by inco-ordination of movements, want of ability to balance one's self, especially with the eyes closed, by shooting pains in the lower extremities, also gastric dis turbances. The pupils do not react to light, but do to accommodation,—the Argyll-Robertson pupil. The reflexes be come lost, there may be ptosis or stra bismus, or even a commencing optic atrophy, and as the disease advances paraplegia with loss of control of the sphincters. (See LOCOMOTOR ATAXIA.) Treatment.—The disease is practically incurable. When it seems very active complete rest may be enjoined, but when it is slow, then supports may be applied to the joints so that they can be used as long as possible. It is in the highest de :Tree ad\ isable not to subject these joints to °per:16%e procedures. It is a great tt niptation to recommend the removal of a lutib w hose knee-joint is absolutely disor:anized; but doing so may result in the death of the patient, because the at ttnipt at healing may be slight or totally lacking.
Conservative and palliative treatment is to be advised and the joint given all the support possible. Of course, the treatment proper for ataxia is to be 'iven. as well as local attention to the affected joint.
Septic Arthritis.
The joints frequently are attacked by an inflammation of a septic character while there co-exists a septic disease af fecting the body generally. This infec tion is caused by a pus-producing or ganism, the staphylococcus. Pyinia, typhoid and other fevers, and the puer peral state are the diseases most often ac companied by septic joint-affections.
Inasmuch as the condition is much the same in all, they present, to a great ex tent, similar symptoms. The joint be
comes the seat of an effusion, usually with pain. Sometimes only one joint is affected. When such is the case it is apt to be a large one, as the knee or hip. This is frequently the case in puerperal, typhoid, and other fevers. In pymmia several joints are apt to be attacked. The onset is liable to be very insidious and may be passed unnoticed, being masked by the symptoms of the general affection. The pain in the joint may produce a restlessness which may be at tributed to nervous or other disturbance; s.o that the disease may be far advanced when recognized. Sometimes the local disease progresses with great rapidity, pus being present in the joint almost from the first.
A personal study of 52 published and personal cases of arthritis due to the pnettinocoeetts suggests nearly all of the conelusions reached hy Leroux, some of which are here practically repeated: It is a rare affection, found oftener in men, sparing no age. It appears often est during or shortly after croupous pneumonia, sometimes as late as the third week after the crisis-.
It ma.y be primary in the joint, ands severe and even fatal constitutional symptoms may result from the toxmmia thus induced; in these eases of primary pnemnocoecic arthritis pulmonary local ization may or may not occur.
Previous damage to a joint as by trauma, rheumatism, or gout favors the localization. The lesions may be lim ited to the synovia or may be more extensive, involving the cartilages and bones. The periarticular structures may be involved. The subacute cases are sometimes highly destructive to the joint, and the same is true of some of the more acute ones. The lesions are usu ally monartieular (61.5 per cent.), larger joints being of tenest involved. The knee is the joint most frequently af fected. The joints of the upper extrem ity are affected a little oftener than those of the lower, but the difference is insignificant. The condition is recog nized by the ordinary signs of an acute or chronic inflammation of a joint. Ex ploratory aspiration, with bacteriolog ical examination of the tluid, is the only means of recognizing the pnemnococcie nature of the inflammation. The gonor rhceal arthritis and periarthritis have to be carefully excluded, as well as the arthralgias following pneumonia.