. Diseases of bones and joints . cease to lookhereafter for any peculiar effect of toxines or faultymetabolism upon the bone and cartilage, but know-ing the sequence in tuberculosis, and identifying thechanges in the synovia and in the marrow in thistype of chronic arthritis, we can predict fairly wellwhat will happen to the other tissues—the stroma,so to speak. We shall not go here into the minutiae of all thechanges in the various tissues. They have been set (1) In Hale Whites article appears an illustration of an enlarge-ment of a phalangeal joint that lacks only the presence of tuber-cles
. Diseases of bones and joints . cease to lookhereafter for any peculiar effect of toxines or faultymetabolism upon the bone and cartilage, but know-ing the sequence in tuberculosis, and identifying thechanges in the synovia and in the marrow in thistype of chronic arthritis, we can predict fairly wellwhat will happen to the other tissues—the stroma,so to speak. We shall not go here into the minutiae of all thechanges in the various tissues. They have been set (1) In Hale Whites article appears an illustration of an enlarge-ment of a phalangeal joint that lacks only the presence of tuber-cles to be characteristic of joint tuberculosis. DISEASES OF BONES AND JOINTS 119 forth fully by other writers,1 but we may well de-vote a few words to some of the essential featuresof the process. The proliferation of the synovia may be extreme,•and may result in the formation of tags, whosestructure varies. The ligaments are usually thick-ened by increase of their connective tissue. Laterin the disease the synovia may Fig. 51. Skiagram of a case of multiple arthritis of Type II. All the inter-phalangeal joints are involved. Note the bony outgrowths and theirreguar line of the joints. By reason of the lack of mobility in the joint andof the proliferation of the synovia, or of the mar-row, or of both, the cartilage usually becomes fibril-lated, and, suffering in its nutrition, degenerates. 1 Vide Nichols and Richardson. Journal of Medical Research,1909, XXI, 149. Nathan, American Journal Medical Sciences, 1909,CXXXVI, p. 817. 120 DISEASES OF BONES AND JOINTS Erosions appear on its surface. The inflammatorytissue from the marrow may break through the carti-lage into the joint. The joint cartilage in this waymay be destroyed entirely, or, degenerating in itsupper and lower portions, may remain as a thinstrip in the midst of fibrous tissue. Fibrous adhe-sions may form between the degenerated cartilageand its fellow of the other bone entering into thearticulation, or betwe
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