INFECTIOUS PSEUDO-RHEUMATISM IN ADULTS. 99 



results fi-om infection of the umbilicus. French statistics place the 

 mortality at 90 per cent, and German at 75 per cent. 



Curative treatment can only be attempted with any chance of success 

 in the simple exudative form. Even then it is necessary to simultaneously 

 treat the primary disease, such as rachitis or diarrhoeic enteritis. 



The recommendations of former practitioners as to the use of saline 

 purgatives, cream of tartar, etc., were probably due to their having recog- 

 nised that diarrhoea is sometimes the primary cause. 



Moussu has seen simple exudative arthritis in rachitic subjects 

 disappear, together with the rachitis, under proper treatment. 



The indications therefore are, firstly, to take measures against the 

 primary disease, treating the local lesions separately with blisters, douches, 

 or simply cold applications and massage. Provided the general condition 

 can be improved, recovery may follow. 



Unfortunately, this treatment is useless against infectious rheumatism 

 with suppurative arthritis resulting from infection of the umbihcus. In 

 such cases treatment, if undertaken, should be directed towards perfectly 

 disinfecting the umbihcal wound or any existing sinuses. 



Injections of strong carbolic solution, the application of antiseptic 

 ointments or of antiseptic pencils containing iodoform, salol, etc., into the 

 sinuses, followed by a surgical dressing covering the umbilicus, form the 

 basis of this primary treatment, which, it need scarcely be said, has little 

 chance of checking the course of already existing arthritis. The use of 

 internal antiseptics and of antipyretics like camphor, salicylate of soda, 

 etc., is worthy of trial. On the other hand, prophylactic treatment in an 

 infected area has every chance of succeeding. The use of dry, clean 

 litter under the mother and the new-born calf, thorough cleansing of 

 the umbilical cord or umbilical cicatrix, and the application to the 

 umbilicus of a small surgical dressing or even a smear of tar, almost 

 always suffice to prevent the occurrence of these forms of arthritis. 



INFECTIOUS PSEUDO-RHEUMATISM IN ADULTS. 



The infectious pseudo-rheumatism of adults differs from infectious 

 rheumatism in young animals in that it never becomes complicated 

 with suppurative arthritis, and rarely affects more than one joint at 

 a time. The hind limbs are the parts usually attacked, and the joints 

 seem predisposed to disease in the following order of frequency : the 

 femoro-tibial, coxo-femoral, and hock joints. 



On account of its greater frequency in cows, it has been termed 

 "arthritis of milch cows" and "infectious arthritis of milch cows," etc. 

 In reality it may also attack bulls and oxen, but such cases are 

 exceptional. 



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