American practice of surgery : a complete system of the science and art of surgery . mportance for both prog-nosis and treatment. It is unusual that the tendency to hemorrhage doesnot first manifest itself elsewhere than in the joints. Occasionally, is the first evidence that the patient has of the existence of thehemorrhagic tendency. In some cases the symptoms are purely those of aneffusion into a joint, and it would be impossible to know what the character ofthe effusion is if the observer were not cognizant of the presence of a hemor-rhagic diathesis. In other cases t
American practice of surgery : a complete system of the science and art of surgery . mportance for both prog-nosis and treatment. It is unusual that the tendency to hemorrhage doesnot first manifest itself elsewhere than in the joints. Occasionally, is the first evidence that the patient has of the existence of thehemorrhagic tendency. In some cases the symptoms are purely those of aneffusion into a joint, and it would be impossible to know what the character ofthe effusion is if the observer were not cognizant of the presence of a hemor-rhagic diathesis. In other cases the oft-repeated effusions of blood into a joint cause some :,:,4 AMERICAN PRACTICE OF SURGERY stiffness and under certain circumstances deformity, this state of affairs beingdue, of course, to the organization of the clots successively deposited. Thecharacter of the fundamental defect in the composition of the blood, prevent-ing its coagulation, is not known, so that there is very little to be said regard-ing the pathology of this condition. The changes produced within the joints. Fig. 245.—Lateral View of Elbow, showing Distention of the Capsule and Separation of the Articu-lar Surfaces of the bumerue and ulna, due to the presence of blood within the joint. (Original.) by the presence of the effused blood have of course no causal relation to thediathesis, and are purely secondary. As regards the etiology, also, nothing is known beyond the fact that it ishereditary to a very considerable degree and that the transmission of the he-reditary defect is through the male descendants. In considering this subject it may be well to relate the essential points inthe clinical course of two cases recently under observation: NON-TUBERCULOUS INFLAMMATIONS OF JOINTS. 555 A boy of eight years was brought for consultation because of a limp in the leftleg and some pain following a wrench while playing. There was restriction in themotion of the hip in all directions, but this restriction did no
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