Joint complications in this disease have been recognized from the earliest times. One hundred and fifty years ago Strack expressed himself thus: “If the dysenteric poison affect only the chest, it causes asthma; if the limbs, it produces arthritis; if both, abscess.”
Joint pains and swellings, with other suppurations, have been noted in several of the epidemics of this disease which have ravaged various parts of the world at different times. Postdysenteric arthritis may assume noticeable and even pyemic aspects, and is occasionally fatal. The bones and joints may become involved in painful and even suppurative swellings, not alone during the active stage of the disease, but during the period of convalescence; while mildness of the primary attack does not necessarily provide immunity from later complications. Here thrombosis of large veins or thrombophlebitis are also observed. When the joints are involved it is usually in irregular order and not simultaneously. Joint lesion does not necessarily proceed to suppuration, but perhaps only to the point of edema and fluid exudation or hydrops. In the Cuban and South African campaigns, during which dysentery prevailed, joint complications were noted.
CHOLERA.
Cholera is usually too rapid and too violent in its course to be followed by secondary infections. Nevertheless, Poulet reports from Val-de-Grace several instances of articular and osseous lesions, some of these characterized by effusion of fluid which was sometimes very thick and resembled balsam, while at other times pus was present.
PNEUMONIA.
Pneumonia having now taken its place as a distinct germ disease, and the micrococcus of Fränkel and the capsule coccus of Friedländer being well established as the active agents in the two principal forms of this disease, pus may be found in other parts of the body. The most common surgical sequels of pneumonia occur as postpneumonic pyarthrosis, which has been wrongly considered a rheumatic affection. These lesions are of embolic or of metastatic origin.
INFLUENZA, OR LA GRIPPE.
This disease has assumed prominence in medical literature, and not a few instances have been reported of surgical sequels—abscesses, purulent ear disease, pyarthrosis, bone lesions, etc. Even necrosis has been repeatedly observed.
MEASLES AND SCARLATINA.
The infectious agent in these affections is not yet recognized and their surgical sequels should be regarded as due to secondary pyogenic infections.