small proportion of
cases certain of them remain stiff and pass into the crippled condition
described under chronic rheumatism. There is no call for operative
interference.

#Gonococcal Affections of Joints.#--These include all forms of joint
lesion occurring in association with gonorrhoeal urethritis,
vulvo-vaginitis, or gonorrhoeal ophthalmia. They may develop at any stage
of the urethritis, but are most frequently met with from the eighteenth
to the twenty-second day after the primary infection, when the organisms
have reached the posterior urethra; they have been observed, however,
after the discharge has ceased. There is no connection between the
severity of the gonorrhoea and the incidence of joint disease. In women,
the gonorrhoeal nature of the discharge must be established by
bacteriological examination.

As a complication of ophthalmia, the joint lesions are met with in
infants, and occur more commonly towards the end of the second or during
the third week.

The gonococcus is carried to the joint in the blood-stream and is first
deposited in the synovial membrane, in the tissues of which it can
usually be found; it may be impossible to find it in the exudate within
the joint. The joint lesions may be the only evidence of metastasis, or
they may be part of a general infection involving the endocardium,
pleura, and tendon sheaths.

The joints most frequently affected are the knee, elbow, ankle, wrist,
and fingers. Usually two or more joints are affected.

Several clinical types are differentiated. (1) A _dry poly-arthritis_
met with in the joints and tendon sheaths of the wrist and hand,
formerly described as gonorrhoeal rheumatism, which in some cases is
trifling and evanescent, and in others is persistent and progressive,
and results in stiffness of the affected joints and permanent crippling
of the hand and fingers.

(2) The commonest type is a _chronic synovitis_ or _hydrops_, in which
the joint--very often the knee--becomes filled with a serous or
sero-fibrinous exudate. There are no reactive changes in the synovial
membrane, cellular tissue, or skin, nor is there any fever or
disturbance of health. The movements are free except in so far as they
are restricted by the amount of fluid in the joint. It usually subsides
in two or three weeks under rest, but tends to relapse.

(3) An _acute synovitis_ with peri-articular phlegmon is most often met
with in the elbow, but it occurs also in the knee and