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the joint disease resulting from malignant disease and acti- nomycosis. After eliminating these, there remained a group which were in general subacute Tricor 145mg or chronic, characterized by joint pain and swelling; they were nonsuppurative, gen- erally progressive, and characterized by exacerbations and remissions, and were liable to result in Tricor 145 disability or de- formity if untreated. These cases might be polyarticular or monarticular, and they might occur at any age after infancy. In a most casual glance over current literature he had found forty-eight names for this class of cases or for parts of it, including foreign synonyms or obsolete names. We were familiar with the group or its members under the names of rheumatoid arthritis, rheumatic gout, chronic rheumatism, osteoarthritis, etc., etc. There was no agreement as to a name for the group or as to existing classification. He re- called the fact that but a few years ago there were many names describing tuberculous joint disease, while to-day one heard but the one name. On the subject of nontuber- culous joint disease the medical community seemed to have gone classification-mad, and he pleaded for greater simplic- ity. Provisionally he would call the whole group arthritis deformans. The gross pathological changes found in these cases consisted of one or more of the following types: (l) Chronic serous synovitis, with thickening of the synovial membrane. (2) The development of synovial villi. (3) Ulcerative arthritis, with destruction of areas of the joint cartilage. (4) The formation of ankylosis. (5) The pro- liferation of bone around the joint margins. The fibrilla- tion of cartilage was frequently associated with all of these conditions, and the types might be associated clinically in any combination. Certain cases of chronic arthritis de- formans had their onset during the occurrence of a general infectious disease. The onset in many cases was indistin- guishable from what was called acute articular rheumatism. Schiiller had described a dumb-bell bacillus which he asso- ciated wholly with the form characterized by villi. They could be cultivated, and when isolated Tricor Cost would cause similar Tricor 145 Mg joint affection in animals. He cited a number of investi- gators who had found bacilli in the synovial fluid in cases of this class. Trauma was recognized as a localizing cause of certain cases of arthritis deformans. He reviewed the nervous theory, which assumed that the pathological changes were due to reflex nervous disturbances in the spinal cord. He also spoke of the metabolic theory, which assumed a dyscrasia, or disturbance of metabolism, as the cause of changes, the symmetry of the lesions and the general Oct. 20, 1906] MEDICAL RECORD. 631 symptom complex being the basis of the theory. E.Kamina- tion of e.Ncrcla had failed to give support to this theory. Two or more etiological causes under certain conditions were capable of producing one or more of five pathological results. The etiological sources bore no constant relation to the pathological results. The pathological results were grouped in no constant relation, either to the etiological causes or to each other. Such being our limited knowledge, it would be an advantage to have a classification which did not overrun the boundaries of our knowledge. It was well known that there were distinct clinical types frequently Tricor Mg seen, and it was safer to assume that these were types rather than separate diseases, until the entity of each separate disease was proved. In shortf he advocated the view that until proven by sufficient evidence to be separate diseases, the conditions which he had spoken of as types of arthritis deformans should be spoken of as arthritis deformans with proliferation of bone, arthritis deformans of the ankylosing type, etc., and that separate diseases should be recognized only when their entity had been established by the same class of evidence that we would accept as valid in other departments of medicine and sur- gery, namely, by discovery of their etiology. Fortunately our treatment of this class of dis- eases was far in advance of our theoretical knowledge of their causes and relation to each other. We had ceased to impoverish the patient by irrational diet, and we realized that salicylate of sodium and iodide of potassium did not cure arthritis deformans. The cardinal points of modern treatment were now recognized as (a) nourishing diet of the kind best assimilated by the patient, supplemented by tonics, if necessary, (b) Regularity of the daily routine in the avoidance of overwork and exposure, and the establish- ment of proper hygienic surroundings, (f) Stimulation of the elimination of waste products by the skin, kidneys, and bowels. The local measures aimed at checking the process in the joint by the avoidance of undue traumatism, the restoration of the local circulation, and the stimulation of the muscle controlling the joint, (rf) The great importance of rest as a curative factor during periods of irritation had been brought to notice by Gibney and Sayre. (,e) The local circulation was to be stimulated and the muscular condition improved by massage, Tricor Coupon baking, douches, and electricity. (/) The treatment by congestion of these parts, as described by Bier, deserved especial mention, (g) If obstruction e.x- isted in the way of tumors or bony outgrowths to the e.x- tent of causing disability, they should be removed by sur- gical measures, (/i) If any ankylosis occurred at a vicious angle, the limb might be straightened. The relation of arthritis deformans to so-called acute articular rheumatism was a question which we could not settle as yet. This was a problem to be settled in the near future. He advocated restricting our classification to our facts, subdividing only so far as data justified us in so doing, and in the meanwhile to use a fairly unobjectionable term. Bone Syphilis, Hereditary and Acquired. — Dr. Rob- ert W. T.^YL0R read this paper. In speaking of early and late hereditary syphilis he said that heretofore these lesions had been summed up in Purchase Tricor two words, osteochondritis and periostitis, but that now we had to include many and varied conditions. Acquired syphilis induced in the off- spring two conditions : First, a syphilitic heredity, in which the morbid processes were not specifically luetic, but were the result of a general dyscrasia which lowered the vitality and more or less impaired, retarded, or vitiated the nutri- tive processes, and to which the term dystrophic lesions was given ; and, secondly, true virulent hereditary Cheap Tricor syphilis, in which the virus penetrated the whole body and produced its protean lesion. As instances of hereditary syphilis affecting the bones, one found affections due to backward- ness of development, arrest of development, and imperfect development. In the category of hereditary syphilitic le- sions one found osteochondritis, osteitis, osteoperiostitis, gummaious osteoperiostitis, and gummatous osteomyelitis. As correlated to bone lesions, one found arthropathies in the form of mild and chronic synovitis and deforming syno- vitis, with more or less destruction of Tricor Coupons joints and involve- ment of the juxtaarticular osseous tissues. Dr. Taylor confined his remarks to the study of the specific lesions of hereditary syphilis, and the earliest, most extensive, con- stant and notable lesions were those due to osteochondritis. The changes here seemed to be proliferative, and had not the character of gummatous infiltration. The swelling might develop slowly or rapidly ; after reaching their full size, they usually remained in an indolent condition, caus- ing little pain and interfering but slightly Tricor Fenofibrate with the motion of the joint. Under appropriate treatment they subsided. Degenerative changes sometimes took place in these osseous lesions. The bones most commonly affected were those of the forearm, the leg, the arm, and the thigh. It was ex- ceptional for the victims of multiple bone lesions to sur- vive. Dactylitis syphilitica was then considered, these lesions having the same character as those of acquired syphilis, namely, an osteitis and osteomyelitis. Swellings of the metacarpal and metatarsal bones usually occurred quite early in hereditary syphilis, and might or might not exist with dactylitic enlargements. Buy Tricor Online They might appear as Buy Tricor late as the twentieth year. Dr. Taylor reported in detail a case in which the lesions were osteitis, periosteitis, gum- matous periostitis, and osteomyelitis, and the sequelae were atrophy and loss of bone, elongation of a long bone, and ankylosis of joints and eburnation. Fournier had pointed out an important diagnostic feature, that in the late forms of inherited bone disease there was a decided tendency to the involvement of the terminal extremities of the di- aphyses. In most cases of hereditary syphilitic bone lesions, particularly when the shafts were attacked, there was more or less pain, some parents looking upon them as growing pains. It was a good rule to suspect hereditary syphilis in any bone lesion accompanied by pain, mild or severe, con- tinuous or paroxysmal. Several cases of late hereditary syphilis with elongation of long bones have been de- scribed under the title of partial or local gigantism. Few cases of general gigantism were on record. Hereditary syphilis of the Cost Of Tricor joints was seemingly little understood, and yet it was not of infrequent occurrence. The larger ones were usually involved. The lesion in older children seemed to be an irritative inflammation with more or less effusion, usually without bony involvement, and which subsided coincidentaly with the involution of the exciting cause in the bone structures. In later life, from the sixth to the eighth year onward, synovitis which might be called pri- mary was observed. The affection developed in a slow and insidious manner, ran a chronic course, with little, if any, pain or redness in most cases, allowing some freedom of motion, and showing great tendency to relapse. He stated that syphilis and tuberculosis seemed to go hand in hand together in their lethal Tricor 48 Mg course, and many observations had been made of tissues in which this symbiosis existed. It seemed that syphilitic tissues formed a prolific culture field for the bacillus of tuberculosis. So in all cases one should be on the lookout for this second invasion. Dr. Taylor closed Order Tricor his paper with a consideration of the diagnosis of bone and joint hereditary syphilis. Dr. Henry Ling Taylor said that an extremely common form of joint affection was the gonorrheal, and this might be mono- or polyarticular, and it might appear at any period, even months or years after. Many of the joint affections occurring in the young adult would be found to be due to a gonorrheal infection if the etiology was closely analyzed. He referred to one form, the painful flat-foot, or tarsalgia. This might be associated with osteophytes. Syphilitic bone lesions were not so often found when one considered the prevalence of syphilis. The antirheumatic treatment was usually harmful, and, in the care of these cases, the main indication was to improve the nutrition. 632 MEDICAL RECORD. lOct. 20, 1906 Nontuberculous joint lesions were masquerading under various designations. Dr. Eugene Fuller said that, in gonorrheal rheumatism, for a number of years he had been draining the seminal vesicles; this seemed to be especially efficacious in those chronic cases in which there was pain and distress, and which would not yield to the ordinary forms of treatment. He looked upon the seminal vesicles as he did upon other cavi- ties in the body. After doing this operation upon many cases and getting good results, he came across a man Tricor Online in the City Hospital who had had, for four months, gonor- rheal rheumatism; the seminal vesicles were tumefied and the patient was in a bad condition, perfectly helpless. He drained the seminal vesicles, which resulted in the pain and distress disappearing and the toes could be moved with freedom, a thing he could not do prior to operation. In two and a half weeks the patient was up and around the ward. This case made Dr. Fuller so enthusiastic that he since had Coupons For Tricor operated upon thirteen others for gonorrheal rheumatism. In these fourteen cases he got immediate relief from the rheumatic symptoms. Out of the fourteen cases there were nine cures. Of the five not cured, two left Tricor Price the hospital free from pain and perfectly comfortable ; they sprang into alcoholic and sexual excesses, causing a re- crudescence. These two cases should be placed among the cures. In the other cases drainage was not kept up long enough, although the results were encouraging. Dr. John Rogers, Jr., said that few cases of gonorrhea ever got up any systemic infection ; but when they did, the joints usually became involved. In a certain class of cases the patients appeared to be cured by some special Tricor Prices protec- tion given the organism, and the inference was that this protection was given by some antibody or serum. There appeared to be three classes or groups, viz., (i) those which quickly subsided; (2) those which lasted from six weeks to four months; and (3) those which continued indefinitely for years. In the first and second groups the patients re- covered because of some protection given by the organism ;

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