int
disease is seldom symmetrical, it closely resembles the arthropathy of
tabes. The completeness of the analgesia of the articular structures
and of the overlying soft parts is illustrated by the fact that in one
case the patient himself was in the habit of letting out the fluid from
his elbow with the aid of a pair of scissors, and that in another the
joint was painlessly excised without an anaesthetic.

[Illustration: FIG. 164.--Charcot's Disease of both Ankles: front view.
Man, aet. 32.]

The disease may become arrested or may go on to complete
disorganisation; suppuration may ensue from infection through a breach
of the surface, and in rare cases the joint has become the seat of
tuberculosis.

[Illustration: FIG. 165.--Charcot's Disease of both Ankles: back view.
Man, aet. 32.]

_Treatment_, in addition to that of the nerve lesion underlying the
arthropathy, consists in supporting and protecting the joint by means of
bandages, splints, and other apparatus. In the lower extremity, the use
of crutches is helpful in taking the strain off the affected limb. When
there is much distension of the joint, considerable relief follows upon
withdrawal of fluid. The best possible result being rigid ankylosis in a
good position, it may be advisable to bring this about artificially by
arthrodesis or resection. Operation is indicated when only one joint is
affected and when the cord lesion is such as will permit of the patient
using the limb. The wounds heal well, but the victims of tabes are
unfavourable subjects for operative interference, on account of their
liability to intercurrent complications. When the limb is quite useless,
amputation may be the best course.

_In cerebral lesions_ attended with hemiplegia, joint affections,
characterised by evanescent pain, redness, and swelling, are
occasionally met with. The secondary changes in joints which are the
seat of paralytic contracture are considered with the surgery of the
Extremities.

In cases of _hysteria_ and other _functional affections of the
nervous system_, an intermittent neuropathic hydrops has been
observed--especially in the knee. Without apparent cause, the joint
fills with fluid and its movements become restricted, and after from two
to eight days the swelling subsides and the joint returns to normal. A
remarkable feature of the condition is that the effusion into the joint
recurs at regular intervals, it may be over a period of years. Psychic
conditio