Like rheumatism, gout is a manifestation of a constitutional state, and requires medical care.
Infective Arthritis. These are the arthritic manifestations of diseases as smallpox, scarlet fever, typhoid fever, measles and erysipelas. They are due to infective material deposited from the circulation, and are in every way similar to septic arthritis, which see. There are always suppurative synovitis and osteomyelitis, with a consequent ankylosis of bony structure. The constitutional symptoms are very intense, and free incision and drainage is indicated.
Neuropathic Arthritis. (Charcot’s Disease). This is a peculiar osteoarthritis observed in patients with locomotor ataxia. The disease is an acute one, so far as objective conditions are concerned, there being no pain or constitutional derangements of consequence. Without any injury having been received, the joint, particularly the knee, suddenly swells, the intra-articular effusion becoming abundant. This may soon be absorbed and with it the articular ends of the bones wear away and break down into small fragments. The limb becomes atrophied and shrunken, and the joint itself becomes weak, often flail.
This disease seems to be due to nutritive changes in consequence of changes in the spinal cord nerve centres. There is no satisfactory treatment and the patients must be kept in bed.
CHAPTER X
DISEASES OF THE BONES
Congenital Defects of Bones. Various congenital deformities of the limbs occur because of interference in various ways with the proper and normal formation of these cartilaginous masses. If, for any reason, the cause of which in most cases is not clear, any of these cartilaginous masses fail to be formed in the embryonic tissues, naturally no ossification can occur, and in such cases there may be a partial or complete lack of development of the corresponding bone. The amount of this congenital deformity may vary from the absence of an entire foot, to the absence of one or several digits, or one or more phalanges.
The deformities produced by such a failure to deposit the cartilaginous base of the bones are very numerous, and in some cases lead to great deformity and loss of function. This lack or increase of the reformation in cartilage, results in most extraordinary deformities.