FLUIDS FROM JOINTS I 27 



applies to the bacillus which is possibly the cause of rheumatoid 

 arthritis. 



Streptococci are readily distinguished on microscopical examina- 

 tion, and may be present even if the fluid is perfectly clear. When 

 they are present in a joint which is not the seat of a perforating 

 wound, they indicate a general infection with the streptococcus, 

 ulcerative endocarditis, etc., and the prognosis is most grave. The 

 author was enabled to diagnose a case of streptococcic septicaemia 

 a few hours after the onset of symptoms 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 antistreptococcic 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 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, 

 in cases 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 microscopically or on cultural 

 examination, and in these the bacteria 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 before the fluid was withdrawn or are localized deep down in the 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 syno- 

 vitis, 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. 



