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OSTEO.AKTIIKITIS IN TABES DORSALIS. By Purchase Vpxl James R. Martin, M. D., Philadelphia, Instructor in Orthopclic Surgery. Jefferscn McJical College; Assistant Orthopedic Surgeon, St. Agnes' Hospital; Assistant Orthopedic Surgeon. Jewish Hospital. The purpose of this communication is to present the report of a case of Charcot joint which, though it evidently was not the Generic Vpxl initial symptom, was the first manifestation of tabes dorsalis. In this pa- tient, who was treatetl in the orthopedic dispensary of the JefTerson Hospital, the correct diagnosis was overlooked for some months, which proves that cases of apparently simple monarticular osteoarthri- tis may, in reality, be arthropathic joints. Case. Patient, M. D., man. aged forty-seven years, native of Italy, and a laborer by occupation. Family his- tory, as far as obtainable, negative. Personal history : Had usual diseases of childhood, otherwise good health until the age of forty-one years. At that time had Buy Vpxl Online an eruption on skin, which was mainly confined to his face and chest and was maculopapular in character. He applied at a hospital dispensary for treatment and after several weeks of treatinent the eruption disappeared. A year later, the patient was admitted to a local hospital, where he was told that he was suffering froin a distended and enlarged abdo- men due to "water" from an enlarged liver. He was given. at this time, an intramuscular injection of the emulsion of salvarsan, after which the enlargement of the liver and distention of the abdomen gradually diminished and dis- appeared. Buy Cheap Vpxl He had no recurrence. Patient was a moderate user of beer, seldom touching the stronger alcohols. Present trouble : About twenty months ago patient tripped and fell down several steps, landing upon his hands and knees. He was not particularly inconvenienced Vpxl Online at the time, but he noticed, the next day, that his left knee was swollen and pained him on walking. He persisted, how- ever, for a day or so and then had to stop on account of the severe pain. He was under the care of a practitioner, and in a week or so was able to walk with the aid of a cane. It was at this time (July. 1913) that he went to the orthopedic dispensary of the Jefferson Hospital. He stated that he had pain in his left knee and there was Buy Vpxl found, upon examination, an effusion of the joint and a slight genu varum. A radiograph was taken by Dr. W. F. Alanges, which apparently revealed a typical osteoarthritis of the knee. The synovial inembrane was somewhat thickened, and the presence of small osteophytes were noted. The patient was treated for this condition, coming to the out- patient department irregularly during the summer, but no improvement was observed in the Cheap Vpxl knee ; instead, an in- crease in the angle of the genu varum developed. In the fall, on account of this progressing deformity of the knee joint and the failure to respond to appropriate treatment, the patient was again examined and the follow- ing was found : A fairly well developed and well nourished adult Order Vpxl ; temperature, pulse, and respiration practically nor- mal. An examination of the organs of the chest and abdomen revealed nothing abnormal, except some impair- ment of resonance at the apices of the lungs. The motor symptoms presented were peculiar gait and incoordination. His gait was a swaying and swinging one. with a tendency to hold his legs and feet rather wide apart. He apparently used his cane not only for support, but for guidance as well. There was some incoordination of the movement of the legs ; no wasting of the musculature of the lower extremities; some loss of power in the affected extremity owing to the deformity. Romberg's sign was positive. The sensory symptoms that were presented were, first and foremost, the loss of the tendon reflexes at the knee joint; there was some slight loss of sensation on the plan- tar surface which extended up the inner surface of his ankles and legs. Pain was felt in and around the affected knee joint. It was usually described as being of a dull and aching character, but occasionally was acute and stab- bing. This pain was more severe during damp and cold weather. The pain was seldom severe enough to cause the patient to lose sleep. Eye symptoms : The pupils were unequal in size, the right being larger than the left. The right pupil failed to react to light and the left reacted sluggishly. Both reacted to accommodation. No history of any derangement of function of bladder or bowel could be obtained; no visceral symptoms were present. An Order Vpxl Online examination of the left knee showed a moderate de- gree of genu varum ; no limitation of motion, but rather more mobility than normal on lateral movements. Tlie patella was free. The joint was larger than normal, espe- cially around the head of the tibia where bony prolifera- tion had taken place. A Wassermann examination proved negative. The blood examination proper showed a slight diminution of the number of Purchase Vpxl Online erythrocytes and a hemo- globin of but seventy per cent. The examination of the

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