. Diseases of bones and joints . t ac-cording to the severity and the nature of the in-fection. Under this head would come cases of traumaticor non-traumatic simple synovitis, intermittent hy-drops,1 etc. The process often involves the kneesand no other joints. The bone, the cartilage, and the fibrous struc-tures about the joint show no gross tendency to in- 1 See an interesting article by Klemm, Arch. f. klin. Chirurgie,February, 1912. The author believes that many cases of intermittent hydrops aredue to a chronic infectious (pus) osteomyelitis in the end of thebone. DISEASES OF BONES AND JOI
. Diseases of bones and joints . t ac-cording to the severity and the nature of the in-fection. Under this head would come cases of traumaticor non-traumatic simple synovitis, intermittent hy-drops,1 etc. The process often involves the kneesand no other joints. The bone, the cartilage, and the fibrous struc-tures about the joint show no gross tendency to in- 1 See an interesting article by Klemm, Arch. f. klin. Chirurgie,February, 1912. The author believes that many cases of intermittent hydrops aredue to a chronic infectious (pus) osteomyelitis in the end of thebone. DISEASES OF BONES AND JOINTS 113 volvement. The disease shows no tendency tospread through the other joints. It involves oneor two, and there it stops. It may clear up at anytime and leave no trace, or it may recur or are just as much cases of arthritis de-formans as are the cases with extensive destruc-tion of the bone and cartilage. The infectiousagent here is feeble in its manifestation, and thedisease expends its energy on the Fig. 49. The multiarticular forms of Type I in the fingers. Note theswelling and the flexions (Goldthwait). The diagnosis is to be made with great care, notin the haste of a five-minute office examination. Inall these chronic arthritides our only hope of sue- Necessitycess is in thoroughness and in taking pains. The for care inpatients family history and his own history from *childhood must be known, his occupation, his habits,the dates of every infectious disease, and especiallyof venereal infection or typhoid fever, the possiblesequence of his symptoms upon any of them, the ii4 DISEASES OF BONES AND JOINTS exact course and chronology of his present disease,and all its subjective symptoms. Has he had a pur-ulent otitis, or any symptoms in nose, throat, ton-sils, gastro-intestinal canal, appendix, gall-bladder,or genito-urinary tract? Nothing is too insignifi-cant to mention. A history of recurring traumashould also be sought. All these facts should be
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