On the diagnosis of tubercular joint disease, three papers / A. G. Miller.

Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: On the diagnosis of tubercular joint disease, three papers / A. G. Miller. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    No. I. ON THE DIAGNOSIS OF CHRONIC JOINT TUBERCULOSIS. I HAVE selected the above as the subject of this paper, because, in my experience as a hospital surgeon, it is not difficult to make mistakes in the diagnosis of tubercular joint disease. We see a very great number of these at the Edinburgh Royal Infirmary, and from the statistics of the hospital reports, I gather that the propot tion of tubercular to all other joint affections is from three-fourths to four-fifths.1 In preparing the following paper I have drawn almost entirely from my own experience. Consequently, my views may not coincide with those of other surgeons. I give them, however, to the profession for what they are worth, hoping that they may be of use to some. The affections that, in my experience, are liable to be con- founded with chronic tubercular joint disease are—The hacmo- philic joint; the hysterical joint; sarcoma ; chronic traumatic synovitis ; syphilitic synovitis ; rheumatoid arthritis ; tubercular epiphysitis ; tubercular bursitis ; and tubercular teno-synovitis. Before dealing with the differential diagnosis of chronic joint tuberculosis from these various affections, I would first point out what I believe to be the leading and most reliable characteristics of chronic tuberculosis of the joints of the extremities. These are mainly six :— 1. Mode of onset—history of slight injury, or none. 2. Appearance of joint—pale, ovoid, smooth, etc. 3. Temperature of joint slightly raised. 4. Absence of pain, except on movement. 5. Limitation of movement by muscular spasm. 6. Atrophy of muscles, especially of the extensors. 1. The Mode of Onset.—The patients who mostly come to us with tubercular joints (children and adolescents) are very liable to have injuries, and they are so accustomed to these that they ] In this calculation I do not include spine or sacro iliac cases,—only the joints of the extremities. J B