American practice of surgery : a complete system of the science and art of surgery . Fig. 238.—True Gout. Definite loss of substance of shafts of proximal phalanges of index and littlefingers. Several joints involved. No tophi distingtushable. (Original.) Infectious Arthritis. A large number of joint lesions, single and multiple, are unquestionablyproduced by some toxin or are due to a true bacterial infection. To these,Goldthwait has given the name of infectious arthritis. It is possible todistinguish these by the x-rays, as well as clinically. Indeed, when the clinicaldiagnosis is in doubt,
American practice of surgery : a complete system of the science and art of surgery . Fig. 238.—True Gout. Definite loss of substance of shafts of proximal phalanges of index and littlefingers. Several joints involved. No tophi distingtushable. (Original.) Infectious Arthritis. A large number of joint lesions, single and multiple, are unquestionablyproduced by some toxin or are due to a true bacterial infection. To these,Goldthwait has given the name of infectious arthritis. It is possible todistinguish these by the x-rays, as well as clinically. Indeed, when the clinicaldiagnosis is in doubt, the radiograph often furnishes conclusive evidence. Thejoint lesion in the active stage represents neither essential atrophy norhypertrophy of bone structures. The capsule is thickened and infiltrated, 660 AMERICAN PRACTICE OF SURGERY. with or without excess of fluid in the joint, but with no erosion of joint sur-faces (see Figs. 235-237). The j-rays would suggest that the so-called Stills disease represents anidentical or certainly analogous Fig. 239.—Hereditary Syphilitic Disease. Late manifestations. form. Ep-iphyses little affected. Confluent areas of porosity in diaphyses of both tibiae. Increase in corticalbone, and areas of bone deposit beneath the periosteum in diaphysis of femur on the right side. (Orig-inal.) Gout. True gout seems to be in a class by itself. The tophi are scarcely distin-guishable in the negative, but the loss of substance of the shafts of the bones,as well as the involvement of the joint surfaces, is, in the advanced stages,characteristic (Fig. 238). In interpreting the plates of any of these chronic articular diseases, thestage of the process must be considered if confusion is to be avoided. Thus, THE INTERPRETATION OF RADIOGRAPHS. 661
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