The prognosis is grave,—mortality, 65 per cent.,—largely because of the ac companying bactermmia and involve ment of other more vital parts of the body (meninges, pleura, pericardium, etc.). Yet spontaneous recovery occa sionally follows, even where there is a, purulent exudate. The cases of sup purative pneumococcie arthritis should be treated by immediate incision and drainage. Serous arthritis may often be healed by aspiration, rest, and compres sion. J. B. Herrick (Amer. Jour. Med. Sci., July, 1902).
The joint swells and effusion is usu ally easily diagnosed. On the contrary, the first symptom may be pain. Pain is a very constant symptom of general sep sis and pains in various parts of the body may be complained of before any definite joint disease is visible. The color of the skin over the joint is not apt to be changed at first; but, if disorganization of the joint takes place, then it may be come red and cedematous. In the hip joint, which is exceedingly liable to be come affected in typhoid fever, disloca tion is very apt to occur. If the hip trouble occurs early in the course of the general disease, it may, as in one case in my own experience, be difficult to diag nose the condition from acute hip dis ease of a tubercular character. Multi plicity of lesions always argues for a general infection; therefore, when more than one joint is affected, one is almost sure that the disease is only a local mani festation of a general condition instead of being a distinct and separate local dis ease. Oftentimes if the general disease tends to recovery the local joint trouble may be more of the nature of a synovitis than an arthritis, and may pursue a mild course, particularly if only a single joint is affected. If, however, the general dis ease is grave the local disease is of a purulent character almost from the start, and suppuration may persist a long time, until death finally ends all.
Treatment.—At the onset of the joint trouble measures should be taken to soothe the irritation of the joint and pro tect it. It may be surrounded with cot ton, or lint wet with lead water, and sup ported by leather or pasteboard splints. Sand-bags may also be placed on either side and an ice-cap laid on the joint. Sometimes enveloping the part in hot cloths is most comfortable. A conserva tive course should be pursued as long as the disease is not progressing too fast.
If it assumes a chronic form the joint may be wrapped in lint spread with bella donna and mercury ointment or one of 10- to 20-per-cent. ichthyol, and sup ported by a firm bandage and splints. If, however, the joint-symptoms becoine very active, it should be aspirated and washed out with sterile salt solution or boric acid or weak bichloride solution.
Case of acute suppuration of the knee joint treated by a thirty days' continu ous irrigation malt a weak solution of boric acid, a good and movable joint be ing secured. Treves (Brit. Med. Jour., July 7, 'SS).
Case due to suppurative inflammation of knee-joint. Motion completely re stored by daily use of apparatus consist ing of weight and rope, latter attached to ankle. Bradford (Med. Rec., June 8, '95).
If suppuration becomes marked, free incision with drainage may be necessary.
In these cases free stimulation to sup port the general strength is of the great est importance, because they are liable to last quite a long while and eventually kill the patient by gradual exhaustion.
In suppurative conditions of the wrist and in compound ganglion relief afforded by subcutaneous division of the anterior annular ligament. Stillman (Bull. Gen. de Then, Mar. S, '90).
Syphilitic Arthritis.
Syphilis attacks the joints the same as it does other tissues. It may occur in infancy, from heredity, in the secondary stage, or in the tertiary. In infancy, as well as to a somewhat less extent in adults, the disease is to be diag-nosed and recognized not so much by its own peculiarities as by its surroundings and associations. If there is any point that may be more noticeable in it than in other affections of the joint, it is its less acute and less painful course. In infancy the joint, particularly the knee, come and somewhat—but I not t \eccdin,.:ly painful. nor yery red, ht be 111.1d suit'. and accompanied by atrophy of the muscles. 'lliere is usu a lv presi.nt other manifestations of the disiase. such as skin eruptions, eye af fii tions. notched or pegged teeth, etc. .1 syphilitic history may also often be traced in the parents. As I have seen it in infancy it assumes mostly the syno vial type and yields to specific treatment. Tho disease also attacks the joints in the sLeendary staf.te. It then shows itself as all effusion into the joints, resembling very much rheumatism, but not in a highly-acute form. One's attention to its true character will probably be attracted by the other secondary symptoms. The disease of the joint will assume a mild acute or a subacute form. In the tertiary stage of syphilis the joint disease is mani fested by a deposit of gummatous tissue in the various parts of the joint. The swelling may be more irregular than in rheumatic disease, from the deposit's oc curring in some portions of the joint while other portions are free. As a rule, it does not occasion suppuration, al though ankylosis may occur. This may be fibrous or even bony.