Diseases of the joints and spine / by Howard Marsh.

  • Frederick Howard Marsh
Date:
1910
Catalogue details

Licence: In copyright

Credit: Diseases of the joints and spine / by Howard Marsh. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    120/684 (page 96)
    at a low grade of intensity ; wlien a joint is attacked it gradually becomes enlarged, in part by some effusion, generally of quite limited amount, into its cavity, but chiefly by slowly increasing swelling of the synovial membrane and perisynovial tissue ; pain, unless the joint is actively used, is slight, or entirely absent, and the surface is free from anything beyond a slight degree of heat; stiffness is usually marked, and there is the muscular wasting whicli invariably accompanies chronic arthritis of whatever origin. Such a case, instead of conforming to the usually accepted type of gonorrhojal arthritis_^ bears a very close resemblance, from a clinical point of view, to tuberculous disease. And tte likeness is readily explained. It is due to the fact that, under the influence of its environment, the gonococcus has been deprived of so much of its original virulence, and is in such small quantity, that the degree of irritation wbicb it produces is practically identical witb that to which the tubercle-bacillus gives rise. The point is, as already stated, one of great importance, for un- doubtedly many cases—for instance, of disease of the knee-joint—are diagnosed and treated as tuberculous when in reality they are not tuberculous but septic in their origin. Some few years ago, A. B , a man aged 27, was sent up to St. Bartholomew's Hospital for admission, as he was be- lieved to be suffering from tuberculous disease of the right knee, of five months' duration. On exammation all the symptoms fitted in exactly with this view—the considerable and uniform swelling dependent on pulpy thickening of the synovial membrane, and a little fluid in the cavity ; the slight surface warmth, the stiffness, and the marked muscular wasting, to- gether with pain, usually slight but becoming marked when any attempt was made to use the limb. To all appearances here plainly was a case of tuberculous disease. But it was ascer- tained that the patient had a very slight gleet remaining after gonorrhoea contracted nine months previously. A bougie was passed, and narrowing of the bulbous portion of the urethra