ACUTE INFECTIONS OF THE KNEE-JOINT AND THEIR SURGICAL TREATMENT

JUDD GOODRICH, M. D.

St. Paul

Only recently have the bacteriological findings been utilized as one of the most valuable adjuncts in the differential diagnosis of acute knee-joint infections. A review of the literature impresses one with the fact, that many such cases are operated upon so late in the disease that anchylosis, either partial or complete, is the best result that can be looked for. Any means, then, that will aid in preventing or lessening these disastrous results ought to be generally adopted, and followed as a routine practice.

It has been demonstrated that if cases of acute synovitis or arthitis be subjected to arthrotomy and irrigation within the first twenty-four to forty-eight hours of the disease, in nearly all cases the joint early assumes its natural condition with retention of its normal function.

Since the question of infection has been more carefully studied, the inflammations of so-called idiopathic origin are less frequently met with. The power of many bacteria to withstand the attenuative and destructive action of the body fluids and cellular elements of the blood-stream, serves to explain in many instances the origin of deep-seated inflammations.

The point at which the organism gains access to the body is often undiscoverable, yet usually the tonsil, pharynx, nose, or the intestinal or genital tract furnishes the port of entry. If a septicemia does not ensue, tissues offering the least resistance are attacked, and a local process is the result. A direct contamination of the joint by a penetrating wound or the extension of an inflammation by continuity are the re

go on studying these cases, not only from the laboratory point of view, but full clinical data should be accumulated in each instance, and we should study the transmissibility, not only as indicated in the human being by our clinical records, but by animal experimentation. That these conditions have not yet been found to assume the importance of the condition produced by the diphtheria bacillus should not hinder us from pursuing a thorough scientific study, because from a medical point of view they are extremely important even if as yet they do not appear to be of as great important from a public health point of view.

DR. Louis B. WILSON (Essayist): It was not the writer's intention to exclude from the list other non-diphtheritic anginas than those mentioned. There are a great many others, among which may be those supposed to be due to diplococcus intracellularis mentioned by Dr. Schmauss. The difficulty is in differentiating this organism from the diplococcus of pneumonia when it acts outside of the meninges, yet I think there can be little doubt that it is concerned occasionally in membranous anginas. There are also a great many other bacteria which are found associated with anginas in isolated cases. The typhoid bacillus has been found in a few well authenticated cases, the colon bacillus in others, and so on. I simply wished to call attention to a few of the more important ones which we meet with here in Minnesota, in order to interest the physicians of the state in making further observations on them.

ACUTE INFECTIONS OF THE KNEE-JOINT AND THEIR SURGICAL TREATMENT

JUDD GOODRICH, M. D.

St. Paul

Only recently have the bacteriological findings been utilized as one of the most valuable adjuncts in the differential diagnosis of acute knee-joint infections. A review. of the literature impresses one with the fact, that many such cases are operated upon so late in the disease that anchylosis, either partial or complete, is the best result that can be looked for. Any means, then, that will aid in preventing or lessening these disastrous results ought to be generally adopted, and followed as a routine practice.

It has been demonstrated that if cases of acute synovitis or arthitis be subjected to arthrotomy and irrigation within the first twenty-four to forty-eight hours of the disease, in nearly all cases the joint early assumes its natural condition with retention of its normal function.

Since the question of infection has been more carefully. studied, the inflammations of so-called idiopathic origin are less frequently met with. The power of many bacteria to withstand the attenuative and destructive action of the body fluids and cellular elements of the blood-stream, serves to explain in many instances the origin of deep-seated inflammations.

The point at which the organism gains access to the body is often undiscoverable, yet usually the tonsil, pharynx, nose, or the intestinal or genital tract furnishes the port of entry. If a septicemia does not ensue, tissues offering the least resistance are attacked, and a local process is the result. A direct contamination of the joint by a penetrating wound or the extension of an inflammation by continuity are the re

go on studying these cases, not only from the laboratory point of view, but full clinical data should be accumulated in each instance, and we should study the transmissibility, not only as indicated in the human being by our clinical records, but by animal experimentation. That these conditions have not yet been found to assume the importance of the condition produced by the diphtheria bacillus should not hinder us from pursuing a thorough scientific study, because from a medical point of view they are extremely important even if as yet they do not appear to be of as great important from a public health point of view.

DR. LOUIS B. WILSON (Essayist): It was not the writer's intention to exclude from the list other non-diphtheritic anginas than those mentioned. There are a great many others, among which may be those supposed to be due to diplococcus intracellularis mentioned by Dr. Schmauss. The difficulty is in differentiating this organism from the diplococcus of pneumonia when it acts outside of the meninges, yet I think there can be little doubt that it is concerned occasionally in membranous anginas. There are also a great many other bacteria which are found associated with anginas in isolated cases. The typhoid bacillus has been found in a few well authenticated cases, the colon bacillus in others, and so on. I simply wished to call attention to a few of the more important ones which we meet with here in Minnesota, in order to interest the physicians of the state in making further observations on them.

ACUTE INFECTIONS OF THE KNEE-JOINT AND THEIR SURGICAL TREATMENT

JUDD GOODRICH, M. D.

St. Paul

Only recently have the bacteriological findings been utilized as one of the most valuable adjuncts in the differential diagnosis of acute knee-joint infections. A review of the literature impresses one with the fact, that many such cases are operated upon so late in the disease that anchylosis, either partial or complete, is the best result that can be looked for. Any means, then, that will aid in preventing or lessening these disastrous results ought to be generally adopted, and followed as a routine practice.

It has been demonstrated that if cases of acute synovitis or arthitis be subjected to arthrotomy and irrigation within the first twenty-four to forty-eight hours of the disease, in nearly all cases the joint early assumes its natural condition with retention of its normal function.

Since the question of infection has been more carefully studied, the inflammations of so-called idiopathic origin are less frequently met with. The power of many bacteria to withstand the attenuative and destructive action of the body fluids and cellular elements of the blood-stream, serves to explain in many instances the origin of deep-seated inflammations.

The point at which the organism gains access to the body is often undiscoverable, yet usually the tonsil, pharynx, nose, or the intestinal or genital tract furnishes the port of entry. If a septicemia does not ensue, tissues offering the least resistance are attacked, and a local process is the result. A direct contamination of the joint by a penetrating wound or the extension of an inflammation by continuity are the re