American practice of surgery : a complete system of the science and art of surgery . symptoms which are suggestive ofan actual involvement of the articulation. The juxta-epiphyseal lesions are 538 AMERICAN PRACTICE OF SURGERY. very well illustrated in the accompanying x-ray picture (Fig. 237). The largernumber of osseous lesions which occur are of this character. They arc quiteas abundant as the periostea] and cortical lesions in the middle of the shaftsof the long bones. Gummatous deposits in the synovial membrane are more rare than the os-seous lesions, but they do occur. Inasmuch as they ra
American practice of surgery : a complete system of the science and art of surgery . symptoms which are suggestive ofan actual involvement of the articulation. The juxta-epiphyseal lesions are 538 AMERICAN PRACTICE OF SURGERY. very well illustrated in the accompanying x-ray picture (Fig. 237). The largernumber of osseous lesions which occur are of this character. They arc quiteas abundant as the periostea] and cortical lesions in the middle of the shaftsof the long bones. Gummatous deposits in the synovial membrane are more rare than the os-seous lesions, but they do occur. Inasmuch as they rarely suppurate, andthus do not have the capacity for eroding their way rapidly through tissue,they may cause a very considerable infiltration in the synovial membrane wherethey are situated without causing any disturbance in the neighboring articu-lation. This is one of the characteristic features of the synovial syphiliticlesions, whether they be gummatous or consist of a diffuse infiltration of theentire synovial layer. Except for the swelling which they undergo, and the occa-. Fig. 237.—Shows on Both the Tibia and the Femur the Extreme Epiphyseal Rarefaction whichis characteristic of the juxta-epiphyseal syphilitic disease. (< Original.) sional mechanical interference with the function of the articulation, they arequite apt to go unrecognized or to be regarded in such a trivial light by thepatient that no advice is sought until the lesion is well advanced. A typical case of this sort is worth recording, if only to emphasize thetype: A young man of twenty-eight presented himself because of a swelling ofthe right knee. This had been of gradual development, was not associated withmuch, if any, discomfort, and had interfered only in a very slight degree withthe function of the joint. He was employed in a railway watch-tower, and it wasnecessary for him to put a rather severe strain upon his joints, but he was able todo his work and did not have to give it up at all on accou
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Keywords: ., bookauthorbuckalbe, bookcentury1900, bookdecade1900, bookyear1906
