The Articulations 361 



ease are the knee, stifle, feet, and hip joints. The affection is am- 

 bulatory in nature and tends readily to recur. Serous membranes 

 are frequently involved, notably the pleura, pericardium, endocar- 

 dium, and meninges. The chronic form commonly succeeds the 

 acute, though it frequently occurs as such from the start, the femo- 

 ro-tibial and carpal articulations being common seats. In this 

 form there is thickening of the capsule with . formation of peri- 

 articular adhesions and sometimes osseous vegetations. 



Purulent arthritis may also be acute or chronic. When acute, 

 pyogenic microorganisms figure as the causative factor, and when 

 chronic, tubercular bacilli. In the acute form, a free purulent se- 

 cretion is characteristic, and when of pyemic origin, several joints, 

 may be affected. The disease pursues the same course as in the case 

 of infected wounds of joints, the joint tending to rapid disorganiza- 

 tion. The capsule gives way and discharges externally. Should the 

 inflammation subside, interarticular granulations spring up, and 

 these undergoing ossification, ankylosis results. In pyemic arthri- 

 tis of the new-born following omphalo-phlebitis, the foci ordinar- 

 ily develop in the shoulder, elbow, knee, hip, and stifle joints, and 

 often undergo spontaneous recovery. In the chronic tubercular 

 form, the internal face of the sac is covered with vegetations, the 

 synovia is slightly purulent and reddish in color, the bacilli are found 

 present, and there are invariably tubercular lesions elsewhere. This 

 form of the disease is very rare. A case has been recorded by 

 Cadiot. 



Symptoms and Diagnosis. The symptoms of acute rheumatic 

 arthritis are intense pain on the least movement as manifested by 

 extreme lameness, marked local heat, constitutional disturbance, 

 affection of one or more joints simultaneously, and very frequently, 

 shifting of the disease from one joint to another. In chronic rheu- 

 matic arthritis, the affected joints are stiff and painful, the symp- 

 toms are aggravated by cold and dampness, and several joints 

 may be involved. In simple arthritis of other than rheumatic ori- 

 gin, there is distension of the synovial sac, the movements of the 

 joint are suppressed, and the member may be unable to bear the 

 weight of the body. When chronic, there is little pain but hydrar- 

 throsis. 



The sjrmptoms of purulent arthritis are similar to those that 

 follow infected wounds of joints. There are fever and rapid pulse. 



