American practice of surgery : a complete system of the science and art of surgery . sponding elevation ofthe temperature. This is very characteristic of all processes in which jointsare concerned where toxic absorption is going on. Excess of uric acid in theurine would also be very suggestive of gout. In the x-ray examinations of these infectious cases the lesions are whollyin the soft parts about the joint. There are no sodium-urate deposits andno erosions of the bone or cartilage except in the very severe infections wheresuppurative changes have taken place. In such cases one occasionally s
American practice of surgery : a complete system of the science and art of surgery . sponding elevation ofthe temperature. This is very characteristic of all processes in which jointsare concerned where toxic absorption is going on. Excess of uric acid in theurine would also be very suggestive of gout. In the x-ray examinations of these infectious cases the lesions are whollyin the soft parts about the joint. There are no sodium-urate deposits andno erosions of the bone or cartilage except in the very severe infections wheresuppurative changes have taken place. In such cases one occasionally seescartilaginous erosions in infectious polyarthritis. 552 AMERICAN PRACTICE OF SURGERY. In the differentiation from atrophic arthritis, a disease which is in all prob-ability a metabolic disturbance, there is less likelihood of confusion. So manyjoints are involved in this disease and there is so little local inflammatory reac-tion that one would rarely have cause to suspect gout. The deformities whichdevelop fairly early in the course of the disease are very characteristic. The. Fig. 244.—Shows Enlargement of Metacarpo-phalangeal and Second Row of Phalangeal Articula-tions, due to urate deposits beneath the skin. One of these has ulcerated through. (Original.) deformities of gout are purely the result of infiltration of tissue about the goutyjoint or are due to the presence of urate deposits. The deformities of atrophicarthritis are the result of luxations of joints brought about through the thin-ning of the cartilage. Contracture, or even partial ankylosis, may develop inatrophic cases. These are rare in gout. Occasionally in gout an entire ar-ticulation may disappear, leaving a hypermobile joint, over which the patienthas imperfect muscular control. This is not accompanied by any deformity, NON-TUBERCULOUS INFLAMMATIONS OF JOINTS. 553 as a rule, and commonly takes place in a small joint, as a terminal phalangealarticulation in a finger or toe. From hypertrophic arthritis
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