GONORRLHEAL ARTHRITIS In comparison to gonorrliceal vulvitis which, according to our experience, is rather frequent, gonorrheal joint inflammation in chil dren is decidedly rare. It appears more frequently as a sequel to puru lent ophthalmia; and to gonorrluval urethritis in boys. Arthritis appears most generally in the second or third week subsequent to the local attack. It is especially apt to attack the knee-joints. Among others the temporomaxillary and sternal joints may likewise be at tacked. The a-rticulations are usually very painful, highly reddened and swollen. Puncture shows seropurulent fluid, in which the presence of gonococci of typical stratification can be found under the microscope or even by culture. High irregular fever usually accompanies the affection. The course of the disease is with children and infants in par ticular usually a rapid one, seldom exceeding two or three weeks, and recovery, even functional, is as a rule complete. Complications with tendovaginitis (Sciffert) endocarditis (Chiaso and Isnardi, Schloss mann, Hermann) and pleurit.is (Mazza, Bordoni-Uffreduzzi, Chiaso and Isnardi) occur, but even these affections appear in children as non malignant and curative. A combination of skin-metastases in the form of vesicles and papules is described by Paulsen, with this Hermann mentions gonorrhoeal erythema exudativum and nodosum; Cassal saw an abscess of the skin with gonorrhoeal suppuration in a child eleven years old suffering from multiple gonorrhwal arthritis.
The diagnosis is easy if we call to mind the possibility of the gonor rhoeal nature of the joint affections. In no case of polyarthritis must the examination of the conjunctivae, the vulva, or the male urethra, be neglected. Features distinguishing it from acute articular rheuma tism are the symptoms of an inflammation usually of greater intensity, a longer duration of the localization in single joints, also relatively the monarticular localization, the rarer complication of endocarditis, and finally the poor results of salicylate therapy. In doubtful cases the proof of the presence of gonococci in the joint effusion (which by the way is not always successful) must decide.
The treatment brings results. Enveloping with cotton wadding and fixation of the joints generally suffices. With children beyond the nursing age a trial with sodium salicylate is at least advisable.
Hermann records a prompt result after an intravenous injection of collargol [3.0 c.c. (it 45) of a 2 per cent. solution for a fourteen-year-old boy]. In severe cases it would be well to take this method of treat ment into consideration. Exceptionally it may become necessary to resort to arthrotomy (Paulsen). Of especial importance is a thorough removal of the source of gonococcus infection.