4 THE TONER LECTURES. 



parotitis, etc., but it lias been observed in cases in which no 

 such complication existed. Pyemic arthritis, like the gangrene 

 from pressure, parotitis, etc., is most apt to occur in severe 

 cases, in which the blood change is at its maximum, and the 

 " typhous crasis," as Stokes has expressed it, possibly becomes 

 converted into p3'emia. 



It is, however, the monarticular form, which will most inte- 

 rest us. It affects the larger joints, such as the elbow and 

 shoulder, the ankle and knee, but above all the hip. The 

 pain is usually slight. The swelling is generally readily 

 observed in all joints except the hip and the shoulder, where it 

 is probably obscured by the muscular masses about these 

 joints combined with the tardy increase in the swelling. Usu- 

 ally it arises spontaneouslj', but occasionally from periostitis 

 or necrosis extending into the joint. It rarely produces sup- 

 purative or fistulous openings. The result is, therefore, gene- 

 rally a gradual return to usefulness, although in 3 cases I 

 have found anchylosis. Of 43 cases, the lower extremities 

 were affected in 39, the upper in only 1, 3 of the cases involv- 

 ing a joint in both, for occasionally two large joints are affected 

 at once. Arthritis, therefore, resembles other surgical febrile 

 affections, such as gangrene, necrosis, etc., in affecting mainly 

 the lower extremities, as do also thrombosis and the ordinary'- 

 oedema. The frequency of these joint troubles is not great. 

 According to Giiter'bock, in a series of years in the Charite 

 (Berlin) and the Hamburg Hospitals, not a case occurred, and 

 in the Vienna General Hospital from 1808 to 1871 onl}^ 2 cases 

 among 3130. Murchison does not even name this complication 

 at all, nor do any other of our text-books, either on surgery 

 or practice, except a few lines by Tolkmann, in Pitha and 

 Billroth's Ilandbuch. Giiterbock and Hellwig are the only 

 authors who have treated them at all fu-Uy. Yet that they are 

 of great importance, and demand our utmost attention, will be 



