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Updated: June 11, 2025
Summarizing it appears from the preceding facts that it is possible to produce at will, purulent infections with no elements of putrescence, putrescent purulent infections, anthracoid purulent infections, and finally combinations of these types of lesions varying according to the proportions of the mixtures of the specific organisms made to act on the living tissues.
Not only must the mechanism of the body be cleansed and freed from obstructive and destructive materials, but the injured parts must be repaired, morbid growths and abnormal formations dissolved and eliminated and lesions in the bony structures corrected by manipulative treatment.
In all cases of sudden death think of angina pectoris and the rupture of an aneurism. Aortic incompetence. Rupture of heart. Rupture of a valve. Rupture of aortic aneurism. Embolism of coronary artery. Angina pectoris. Cerebral hæmorrhage or embolism. Mitral and tricuspid valvular lesions if the patient exerts himself.
The probability of chronic inflammation and weakening of the heart muscle from such slow-going and continuous infection must be recognized, and the source of such infection removed. The determination of the presence of valvular lesions is only a small part of the physical examination of the heart.
The rapidity of the destructive changes in certain cases of tabes, and the entire absence of joint lesions in others, would favour the view that special parts of the spinal medulla must be implicated in the former group. Except that the joint disease is seldom symmetrical, it closely resembles the arthropathy of tabes.
Lupus usually begins earlier in life, it presents apple-jelly nodules, and lacks the rounded, elevated border. Syphilitic lesions progress more rapidly, and also lack the characteristic margin. The differentiation from squamous epithelioma is of considerable importance, as the latter affection spreads more rapidly, involves the lymph glands early, and is much more dangerous to life. Treatment.
General Complications. In some cases a multiplicity of lesions in the bones and joints imparts to the disease the features of pyæmia.
The gonococcus is carried to the joint in the blood-stream and is first deposited in the synovial membrane, in the tissues of which it can usually be found; it may be impossible to find it in the exudate within the joint. The joint lesions may be the only evidence of metastasis, or they may be part of a general infection involving the endocardium, pleura, and tendon sheaths.
Of course, like any valvular lesion, it may be associated with other lesions, and sooner or later in many instances, when the left ventricle becomes dilated or weakened, mitral insufficiency also occurs.
Wide variations are met with in the manifestations of the secondary stage, and histologically there is no valid distinction to be drawn between secondary and tertiary lesions.
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