FLUIDS FROM JOINTS. 125 



which is not the seat of a perforating wound they indi- 

 cate a general infection with the streptococcus, ulcera- 

 tive endocarditis, &c., and the prognosis is most grave. 

 The author was enabled to diagnose a case of strepto- 

 coccic septicaemia a few hours after the onset of sym- 

 ptoms by finding numerous chains in a single drop of 

 clear fluid aspirated from the knee-joint. The clinical 

 aspect was at that time very similar to that of severe 

 rheumatism, and the case had been so diagnosed. 



In such cases the use of anti-streptococcic serum 

 offers some hope to the patient, and should be tried. 



Staphylococci are generally found in cases of arthritis 

 due to perforating wounds, or in the course of a general 

 infection. They may also occur along with the gono- 

 coccus in cases of gonorrhoeal arthritis. 



The pneumococcus occurs in general infection from a 

 primary focus in the lung, middle ear, &c., or the course 

 of ulcerative endocarditis. 



The gonococcus occurs in some cases of gonorrhoeal 

 arthritis; it may be present in pure culture, or it may 

 be mixed with other organisms, especially the pus cocci. 

 In other cases of gonorrhceal arthritis no bacteria are 

 found, either microscopically or on cultural examina- 

 tion, and in these the bacteria have probably died out 

 before the fluid was withdrawn. 



The tubercle bacillus may be found in cases of tuber- 

 cular synovitis, but it is far more probable that the 

 most careful search will be unsuccessful. If bacilli 

 having the general appearance of this organism are 

 found in the Gram specimen, the carbol-fuchsin method 

 of staining should be applied to a fresh film. 



Fluid from a joint may be sterile in cases of tuber- 

 cular synovitis, gonorrhoeal arthritis, synovitis due to 

 an aseptic injury, rheumatism, gout, or rheumatoid 

 arthritis, &c. 



