General treatment is to be used along ,with the local. The remedies are well known: codliver-oil with creasote, syrup of the iodide of iron, tincture of nux vomica, and compound syrup of the hy pophosphites are those most commonly used. The late Dr. Goodman used a pre scription composed of:— Bichloride of mercury, / it 24 Or 1/43 grain.
Fowler's solution of arsenic, 1 to 3 drops.
Tincture of iron, 3 to S drops. Syrup of orange-flowers, 1 drachm.
it is a very efficient combination, and acts well in many cases. Careful, per sistent, protective, and conservative treatment is the key-note of success in the management of tuberculous joint diseases.
Sun-baths in the treatment of tuber culous joints. The patient is placed on a, suitable couch in the sunniest part of a garden or other open place. with the affected joint fully exposed to the rays of the sunshine. To protect the head of the patient some sort of sunshade may be improvised. If the upper limb is the seat of the disease, the patient may preferably be allowed to walk about the garden. The duration of the sun-bath should be several hours a day. During the intervals the joint is covered with wool, and rather firmly bandaged. Some times after the first or second bath the joint becomes more painful, but this soon passes away in most cases, but if it should continue it may be necessary to intermit the treatment for several days. Rapid pig,mentation of the skin by the sun's rays has been noticed to coincide with comparatively quick recovery. Millioz (Thi‘se de Lyon, '99; Brit. -Med. Jour., Feb. 10, 1900).
Tuberculous disease tends to recur after apparent cure in a considerable proportion of cases. This recurrence is most commonly a local one. Metastases are not common. Trauma, direct or in direct, is frequently associated with the recurrence. Indirect trauma is probably the exciting cause of the recurrences, especially where partial ankylosis or de formity exists. Patients who have suf fered from bone and joint tnberettlosi.s should be cautioned that they are not well when symptoms have ceased. and that reasonable care -must be exercised to avoid recrudescences. Deformity and shortening should be corrected as far and as accurately as possible to lessen the chance of recrudescence.
-Mechanical treatment, especially fixa tion, should be used in the acute con ditions in childhood. Exploratory in
terference, where discretion is used, with a view to removal of isolated foci, is advisable in many eases in children, and is to be urged in the majority of the recrudescences, if seen early. Recogni tion of the fact that patients with hip disease, Pott's disease, and tumor albus have tuberculosis just as much as if they had phthisis, and .should be treated accordingly, must be insisted upon. C. F. Painter (Boston Med. and Surg. Jour., Jan. 8, 1903).
Loose Bodies in Joints. Symptorns.—The symptoms of the af fection are marked, and are due to inter ference with the function of the joint. The knee is the joint most often affected. The patient, while walking, is apt to ex perience a severe pain in the joint and may either fall or else hold the joint stiff. It may become locked. In some cases the patient can so manipulate the part as to free the loose body and then walking again is possible. These sudden attacks of disability are followed by a swelling of the joint and all the symp toms of an acute synovitis. These re peated attacks supervening on the orig inal injury are apt to cause the joint to be constantly in a state of low chronic inflammation which is more or less dis abling.
Pain so often associated with the pres ence of these bodies is largely due to their tearing the capsule in the move ments of the joint and not to their being caught between the bones. Riesenfeld (1-ireslauer Aerzliche Zeit., Jan. 2S, '88).
Pain occurring with foreign bodies in the joints regarded as due, not to pinch ing of the body between the joint-sur faces, but to stretching of the capsule that takes place 11 hen the body lies in certain positions outside the joint-sur faces. Larsen (Deut. med. Zeit., Apr. 24, '90).
Besides the pain and stiffness which may be produced, the patient has a con tinual sense of distrust, which causes him to avoid using the joint freely, and thus interferes with walking. In many cases there is nothing apparently wrong with the joint until the moment of pinching or jamming of the loose body as the joint is in motion. These patients are usu ally skillful in finding and localizing the loose body, but not always. Often it dis appears on the slightest movement, not to be discovered until it again intrudes itself upon the patient's notice at some inopportune moment.