During the last year and a half 32S cases of joint-inflammation personally observed, of which 61/2 per cent. were -yphilitic in origin. The capsule in syphi litic inflammation of joints often becomes hardened in spots, and lacks the uniform, doughy feel of tuberculosis. Nocturnal Tains noticed in syphilis. Rubinstein Inter. klin. Rund., Sept. 2S, '90).
The main symptoms of syphilitic ar thritis are exacerbating nocturnal pains, \vith fever of a remittent type. The most certain .signs are the demonstration of gummata in tile capsule of the joint, to gether uith a thickening of the capsule, effusion into the joint, and a "cracking" sound when the joint is moved. Cipriani (Deut. med.-Zeit., Sept. 24, 1900).
ionorrhteal arthritis is a joint infec tion due to a specific micro-organism toxic- products of the same, trans mitted through the blood to an articu lation susceptible to infection either from previous traumatism or all inher ent 'auk of resistance. The term gonor rliteal rheumatism is a misnomer, both a, regards diagnosis and treatment. and should be totally abandoned. Ant i rheumatic remedies, although they may relieve pain, will not kill the infecting organism, and are useless. A joint in fection may take place either coinci dently with or several weeks after the apparent cure of the specific urethritis. If the joint is tapped early, the diplo coccus will be found to be present; later, it may have died. The diagnosis depends largely upon microscopical ex amination and the laboratory culture. The only rational treatment is the prompt removal of the infecting micro organism by arthrotomy and free irri gation with antibacillary fluids. De Forest Willard (Therap. Monthly, July, 1902).
Treatment.—If the true nature of the disease is recognized, antisyphilitic meas ures are to be employed. In infancy mercurial inunctions are best. In adults inunctions are desirable if it can be made convenient to use thern,—if not, then internal medication. The biniodide of mercury beginning with about 1/„ grain and rapidly increasing to a quarter or more three times daily is my preference. The green iodide of mercury 1/4 grain three times daily or a mixture of bichlo ride of mercury and iodide of potassium or sodium in compound syrup of sarsa parilla are also favorite forms of medica tion. In doubtful cases iodide of potas sium or sodium should be given, as it is likely to be of benefit whether the case is one of syphilitic or rheumatic origin.
Locally the methods used for other forms of arthritis are to be used, but the joint may be covered with lint spread with belladonna and mercury ointment.
Tubercular Arthritis. (See also Mr JOINT DISEASE, volume iii.) Tubercular arthritis is the name given to what was formerly known as scrofu lous or strumous disease of the joints. When the knee-joint was affected, it was called tumor albus; it has also been called gelatinous arthritis. It is now positively known that the characteristics of this disease are due to the tubercle bacillus, and that in its pathology it is a true tuberculosis affecting the bones and joints. The tubercular process is a local one; it may and often does occur in company with other tuberculous manifestations elsewhere, but it is late in the course of the disease. The tuber cle bacillus becomes disseminated and starts up tubercular processes elsewhere.
In the commencement, the joint, or the adjacent bone, alone is affected. The part becomes infiltrated with small cells, giant cells form; caseation, pus, and necrosis forins; and the bones become destroyed and the joint disorganized. The oricrin of the diseqse -process is of I the greatest importance. Cases occur which look clinically as if the joint alone was involved; as if it was the seat of a tubercular synovitis and that alone. In other cases it is evident that disease of the bone is present, as well as of the synovial membrane. Almost all surgical authors describe these two forms of joint tuberculosis. Most of them regard tbe osseous form as being the more frequent, but also that the synovial form is very C0171M011.
The early recognition of tubercular lesions of the joints is of great impor tance. It is a great mistake to suppose that joint pains in children are due to rheumatism. Another prevalent error is that only the children of tubercular parents are liable to develop tubercu lous lesions of the joints. In making a . diagnosis in the early stages, the most significant symptom, and the one which should make the physician suspicious and cause him to put the part abso lutely at rest, is muscular rigidity_ Pain, tenderness, and inflammation may be entirely absent in these cases in the beginning, and therefore are not at all necessary to a proper diagnosis. De Forest Willard (Jour. Amer. Med. Assoc., _Apr. 13, 1901).