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The commonest form hydrops is that in which the synovial sheath is distended with a viscous fluid, and the fibrinous material on the free surface becomes detached and is moulded into melon-seed bodies by the movement of the tendon. The sheath itself is thickened by the growth of tuberculous granulation tissue. The bodies are smooth and of a dull-white colour, and vary greatly in size and shape.
She then took a grain of opium, and five grains of rhubarb, every night, night, for many weeks; with some slight chalybeate and bitter medicines, and has suffered no relapse. Hydrops Thoracis. A tradesman, about fifty years of age, became weak and short of breath, especially on increase of motion, with pain in one arm, about the insertion of the biceps muscle.
In the secondary stage, a synovitis with serous effusion is not uncommon, and may affect several joints. Syphilitic hydrops is met with almost exclusively in the knee; it is frequently bilateral, and is insidious in its onset and progress, the patient usually being able to go about.
Hypertrophied fringes and pedunculated or loose bodies often co-exist with hydrops, and give rise to characteristic clinical features, particularly in the knee. The fringes, especially when they assume the type of the arborescent lipoma, project into the cavity of the joint, filling up its recesses and distending its capsule so that the joint is swollen and slightly flexed.
In aggravated cases the tips of the fingers disappear from progressive ulceration, and in the sole of the foot a perforating ulcer may develop. Arthropathies are occasionally met with, the joints becoming the seat of a painless effusion or hydrops, which is followed by fibrous thickening of the capsular and other ligaments, and terminates in stiffness and fibrous ankylosis.
Hydrops Pericardii. A gentleman of temperate life and sedulous application to business, between thirty and forty years of age, had long been subject, at intervals, to an irregular pulse: a few months ago he became weak, with difficulty of breathing, and dry cough.
The clinical features are those of an indolent hydrops, with or without melon-seed bodies, or of uniform thickening of the wall of the bursa; the tuberculous granulation tissue may break down into a cold abscess, and give rise to sinuses.
Among the many private inscriptions in this church, we found one made by Dr. Over, once an eminent physician in this city, on a mother and child, who, being his patients, died together and were buried in the same grave, and which intimate that one died of a fever, and the other of a dropsy: "Surrepuit natum Febris, matrem abstulit Hydrops, Igne Prior Fatis, Altera cepit Aqua."
The commonest type is a chronic synovitis or hydrops, in which the joint very often the knee becomes filled with a serous or sero-fibrinous exudate. There are no reactive changes in the synovial membrane, cellular tissue, or skin, nor is there any fever or disturbance of health. The movements are free except in so far as they are restricted by the amount of fluid in the joint.
In the majority the condition is chronic, and the chief feature is the gradual accumulation of fluid constituting the bursal hydrops or hygroma.
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