FLUIDS FROM JOINTS 1/5 



They may also occur along with the gonococcus in cases of 

 gonorrhoeal arthritis. 



The pneumococcus occurs in general infection from a 

 primary focus in the lung, middle ear, etc., or in the course of 

 ulcerative endocarditis, and may also occur as a primary 

 infection at least, cases occur in which no other lesion is 

 found. The prognosis appears on the whole to be fairly good 

 in these cases of suppurative arthritis of pneumococcic origin, 

 and complete recovery with a fully movable joint may occur. 



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 gonorrhoeal arthritis no bacteria are found, either micro- 

 scopically or on cultural examination, and in these the bac- 

 teria have probably died out before the fluid was withdrawn 

 or are localized deep down in the tissues. 



The tubercle bacillus may be found in cases of tuberculous 

 synovitis, but it is 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 tubercular 

 synovitis, gonorrhoeal arthritis, synovitis due to an aseptic 

 injury, rheumatism, gout, or in rheumatoid arthritis, etc. 



LUMBAR PUNCTURE 



Fluid may be removed from the spinal meninges for a bac- 

 teriological or other examination by means of Quincke's 

 lumbar puncture. The information furnished by this means 

 is often of very great value; in fact, Osier says that "during 

 the past ten years no single measure of greater value in diag- 

 nosis has been introduced." The process is simple, easy, and 

 entirely devoid of danger, and can be carried out without an 

 anaesthetic. Further, a very large amount of benefit is often 

 derived from it, and it must be regarded as the most useful 

 therapeutic agent at our disposal in the treatment of menin- 

 gitis, both acute and chronic; o'ne case at least of tuber- 

 culous meningitis has been cured by repeated punctures. It 

 acts, of course, by relieving the hig~h intracerebral tension and 

 by removing some of the toxin-containing cerebro-spinal 



