eedle of the syringe is easily introduced between the lateral condyle
and the head of the radius. A localised focus of disease in one or
other of the bones may be eradicated without opening into the synovial
cavity.

If the articular surfaces are so involved that recovery is likely to
be attended with ankylosis, the disease should be removed by
operation, and cure with a useful and movable joint may then be
reasonably anticipated within two or three months. When the patient's
occupation is such that a strong stiff joint is preferable to a weaker
movable one, bony ankylosis at rather less than a right angle should
be aimed at.

#Arthritis deformans# occurs as a hydrops with hypertrophy of the
synovial fringes and loose bodies, or as a dry arthritis with
eburnation and lipping of the articular margins.

#Neuro-arthropathies# are met with chiefly in syringomyelia, and are
attended with striking alterations in the shape of the bones and with
abnormal mobility.

#Pyogenic diseases# result from staphylococcal osteomyelitis--chiefly
of the humerus or ulna--and from gonorrhoea.

The remaining diseases at the elbow include syphilitic disease in
young children, bleeder's joint, hysterical affections, and loose
bodies, and do not call for special description.

#Ankylosis# of the elbow-joint, if interfering with the livelihood of
the patient, may be got rid of by resecting the articular ends of
the bones, or by inserting between them a flap of fascia and
subcutaneous fat derived from the posterior aspect of the upper
arm--_arthroplasty_.

THE WRIST-JOINT

The close proximity of the flexor sheaths to the carpal articulations
permits of infective processes spreading readily from one to the
other. The arrangement of the synovial membranes also favours the
extension of disease throughout the numerous articulations in the
region of the wrist.

#Tuberculous disease# is met with chiefly in young adults, but may
occur at any age. It usually originates in the synovial membrane, but
foci are frequently present in the carpal bones, and less commonly in
the lower ends of the radius and ulna, or in the bases of the
metacarpals. The clinical features are almost invariably those of
white swelling, which is most marked on the dorsum where it obscures
the bony prominences and the outlines of the extensor tendons. Wasting
of the thenar and hypothenar eminences, and filling up of the hollows
above and below the anterior annular ligamen