tient being kept
in bed with light weight extension. In the chronic hydrops the fluid is
withdrawn, and about an ounce of a 1 per cent. solution of protargol
injected; the patient should be warned of the marked reaction which
follows.

After all symptoms have settled down, but not till then, for fear of
exciting relapse or metastasis, the joint is massaged and exercised.
Stiffness from adhesions is most intractable, and may, in spite of every
attention, terminate in ankylosis even in cases where there has been no
suppuration. Forcible breaking down of adhesions under anaesthesia is
not recommended, as it is followed by great suffering and the adhesions
re-form. Operation for ankylosis--arthroplasty--should not be
undertaken, as the ankylosis recurs.

TUBERCULOUS DISEASE

Tuberculous disease of joints results from bacillary infection through
the arteries. The disease may commence in the synovial membrane or in
the marrow of one of the adjacent bones, and the relative frequency of
these two seats of infection has been the subject of considerable
difference of opinion. The traditional view of Konig is that in the knee
and most of the larger joints the disease arises in the bone and in the
synovial membrane in about equal proportion, and that in the hip the
number of cases beginning in the bones is about five times greater than
that originating in the membrane. This estimate, so far as the actual
frequency of bone lesions is concerned, has been generally accepted, but
recent observers, notably John Fraser, do not accept the presence of
bone lesions as necessarily proving that the disease commenced in the
bones; he maintains, and we think with good grounds, that in many cases
the disease having commenced in the synovial membrane, slowly spreads to
the bone by way of the blood vessels and lymphatics, and gives rise to
lesions in the marrow.

#Morbid Anatomy.#--Tuberculous disease in the articular end of a long
bone may give rise to _reactive changes_ in the adjacent joint,
characterised by effusion and by the extension of the synovial membrane
over the articular surfaces. This may result in the formation of
adhesions which obliterate the cavity of the joint or divide it into
compartments. These lesions are comparatively common, and are not
necessarily due to actual tuberculous infection of the joint.

The _infection of the joint_ by tubercle originating in the adjacent
bone may take place at the periphery, the osseous