PNEUMOCOCCIC ARTHRITIS Pneumococcic arthritis which has only recently received proper at tention owing to the labors of Pfisterer and Herzog, deserves special mention in these pages, since it is apt to occur in childhood, particularly in the first and second years of life. Bronchitis or pneumonia may or may not precede the arthritis. The pharynx and middle ear may be considered as portals of entrance. Now and then pneumonia follows the joint disease.
The pathology is one of suppurative effusion, with a copious infil tration of the capsule, which like the pus is permeated with diplo cocci positive to Gram's stain, while the cartilage shows little or no noticeable change. The affection is usually monarticular, sometimes oligarticular. The most frequently involved areas are the shoulder, knee, or hip. It is rare to have a true septic course in which many joints participate and lead to death. Complications with meningitis, empyema and peritonitis often occur (Hagenbach, Romheld). Epiphy seal osteomyelitis may exist at the same time and perhaps be taken as the primary cause of the joint suppuration (Herzog).
Diagnostic symptoms are great swelling and widespread inflammatory (edema, with simultaneous pallor of the skin. Notwithstanding the severe local manifestations and the high fever the general physical condition and sleep arc proportionately only slightly impaired.
The differential diagnosis from articular rheumatism and tuber culous coxitis, requires no discussion; however, there is greater proba bility that pneumococcus arthritis will be confounded with gonorrhoeal arthritis. Aside from the primary sources of infection, which can be etiologically proven, it is necessary in all suspicious cases for the verifi cation of the diagnosis in pneumococcie arthritis to make as soon as possible an exploratory puncture. The lancet shaped Gram-positive capsulated diplococci arc easily identified under the microscope. Cul ture and animal inoculation may be of service for positive identification.
The prognosis is unfavorable if the arthritis is only a local manifes tation of a severe general infection; otherwise it depends essentially upon a timely diagnosis and incision. Thick creamy pus gives a better outlook than a thin pus. The curative result is, as a rule, functionally perfect.
As far as therapeutics is concerned, only the earliest and sufficient incision is to be considered. Expectant treatment or puncture are positively to be rejected.