American practice of surgery : a complete system of the science and art of surgery . m, and the local pain and disability at anearly stage are more pronounced. Sooner or later other joints, as a rule, be-come affected. Syphilitic Joint.—The form of chronic synovitis which occurs occasionallyin syphilis is not likely to be confused with tuberculosis. The history of thecase and the progress of the disease enable one to make a diagnosis. Gummata,when they occur about the knee, usually begin in the subcutaneous tissues,and when they appear in the deeper tissue they are found as isolated nodules, 7
American practice of surgery : a complete system of the science and art of surgery . m, and the local pain and disability at anearly stage are more pronounced. Sooner or later other joints, as a rule, be-come affected. Syphilitic Joint.—The form of chronic synovitis which occurs occasionallyin syphilis is not likely to be confused with tuberculosis. The history of thecase and the progress of the disease enable one to make a diagnosis. Gummata,when they occur about the knee, usually begin in the subcutaneous tissues,and when they appear in the deeper tissue they are found as isolated nodules, 700 AMERICAN PRACTICE OF SURGERY. as a rule. The form of syphilitic synovitis to which reference has been madeis usually symmetrically developed, so that both knees are involved. Sarcoma.—A growth of this nature usually begins near one of the epiphy-ses and may be mistaken for tuberculous disease. If it is periosteal in originit appears, as a rule, as a more or less localized and irregular bony tumor,but the more centrally the growth is placed the more likely is it to be niis-. lui. 295.—Affection of the Knee Joint in Haemophilia, Showing the Enlargement of the Joint which inthese Cases may Simulate Tuberculous Disease. The patient was ten years of age. ((>riginal. taken for tuberculous disease in the knee. Such growths make rapid progress,however, and their true nature soon becomes evident in that way. In sarco-mata certain very characteristic signs may be present, such as eggshell crack-ling and occasionally pulsation. Hysterical Joint.—The disability of the joint may simulate tuberculous dis-ease, but the local physical signs of a positive character are absent. Complications.—The fact that an individual suffering from tuberculosislocalized in a joint may become the victim of tuberculous disease elsewherein the body, has already been discussed in connection with hip disease (page652). Tuberculous meningitis or disseminated miliary tubercles, pulmonarytuberculosis,
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