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 gonorrhceal 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 gonorrhceal 
arthritis; it may be present in pure culture, or it may 
be mixed with other organisms, especially the pus cocci. 
In other cases of gonorrheeal 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before the fluid was withdrawn.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, gonorrhceal arthritis, synovitis due to 
an aseptic injury, rheumatism, gout, or rheumatoid 
arthritis, &c. 
