806 Articular Rheumatism. 



were established that articular rheumatisni in a number of cases actually does not 

 arise from a primary disease, because many diseases are known which, although 

 always caused by the same infectious material, now occur as a primary and again 

 as a secondary disease. 



Anatomical Changes. Yellow gelatinous infiltrations are 

 formed in the i:>eriarticular connective tissue. The synovial 

 fluid of the affected joint appears more or less increased, yel- 

 lowish red and turbid ; it contains at times shreds of fibrin, or is 

 exceptionally like pus. The synovial membranes appear swol- 

 len, injected, traversed by small hemorrhages, their inner sur- 

 face is velvety in consequence of swelling of the articular vil- 

 losities, the cartilage of the joint is bluish red, and later on 



Fig. 117. Arlicular Nltcianatism in a Coir. Inilaniniatioii of Jloth Carpal Joints. 



yellow, its surface feels somewhat rough. — In chronic cases the 

 synovial capsule and the surrounding connective tissue is 

 lardaceously thickened (tumor albus). — These changes will 

 generally be found at the same time in several joints. 



In addition inflammatory processes will also be found in 

 the tendon sheaths and sometimes also in some of the internal 

 organs. When the disease continues for a long time great 

 emaciation occurs. 



Symptoms. The inflammation of the joints, which is char- 

 acteristic of the disease, almost always sets in suddenly and 

 affects several joints at the same time or consecutively. The 

 trouble is rarely limited to one joint. Favorite localizations 



