. Syphilis : a treatise on etiology, pathology, diagnosis, prognosis, prophylaxis, and treatment . zed in one or more of the largejoints, but even the fingers may be affected. The swelling maybe either articular or periarticular and may be very skin is red and may look phlegmonous. The temperature mayreach 104°, but there is no definite type of fever. Antisyphilitictreatment usually causes prompt disappearance. In one suchcase which we recently had radiographed, no local lesions couldbe found except a trifling periostitis about an inch above thejoint. The subacute form is simply
. Syphilis : a treatise on etiology, pathology, diagnosis, prognosis, prophylaxis, and treatment . zed in one or more of the largejoints, but even the fingers may be affected. The swelling maybe either articular or periarticular and may be very skin is red and may look phlegmonous. The temperature mayreach 104°, but there is no definite type of fever. Antisyphilitictreatment usually causes prompt disappearance. In one suchcase which we recently had radiographed, no local lesions couldbe found except a trifling periostitis about an inch above thejoint. The subacute form is simply less severe than the form just de- 258 SYPHILIS scribed; it may be subacute from the start, or an acute case maybecome subacute. The chronic type is not so well known. This form is neverassociated with effusion, but is always of the dry type. Four-nier^^ thinks that the crepitating joints of old syphilitics may bedue to an old mild chronic infection. However, treatment hasno effect upon the group of cases that Fournier describes. In all of these cases the diagnosis can not be made from phys-. Fig. 107.—In spite of the fact that the elbow joint was much swollen and very pain-ful, the roentgen ray findings were negative. This was a typical case of pseudorheuma-tism, (Roentgenogram by Dr. Walter Van Sweringen.) ical examination of the joints alone; both thorough physical andlaboratory investigation are required. It can not be too stronglyemphasized that every case of joint trouble, be it acute orchronic, should have a routine Wassermann done. Hydrarthrosis or arthritis with effusion due to syphilis isprobably not so rare as the few case reports in the literaturewould have us believe: it is considered unusual simply becauseit is not more frequently looked lor. This form usually occurs BONES, JOINTS, MUSCLES, TENDONS AND BURS/E 259 before the third year of infection, and Gerin-Roze has reporteda case as early as the tenth day after the appearance of thechancre; it is most freque
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