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Chronic ulcers of the leg are caused by thrombosis and infiltration of the capillaries and stagnation in the smaller veins. A fibrotic ring surrounds the ulcer and cuts it off from the normal blood supply, thus preventing healing. Injection of normal saline solution through the edges is able to break down the fibrotic ring, and promote the formation of healthy capillaries and granulations. This method was also very successful in the treatment of sloughs, following the injection treatment of varicose veins by the sclerosing solutions, and in fact in the sloughs we treated by this method, the healing was extremely rapid.

1. 1. Erythroblasts and myelocytes were demonstrated in the concentrated sediment of effusions in intra-articular fractures of the knee joints. 2. 2. This method gives positive results even in minor injuries of articular surfaces (cracks or avulsions) which are not reproduced in roentgen-ray films. 3. 3. This method is also of value to clarify a doubtful diagnosis. 4. 4. By combining the method of demonstration of fat and elements of bone marrow in traumatic effusions, we worked out a differential diagnosis of the injuries to the knee joint: slight injury where fat is absent; severe injuries when fat is found; intra-articular fractures where elements of bone marrow are demonstrated in addition to the fat in the aspirated joint fluid.

1. 1. Fat was observed in traumatic hemorrhagic effusions of the knee joint. 2. 2. Fat is conveniently discovered by centrifugalizing the aspirated fluid. It accumulates on the surface and causes separation of the fluid into three or four layers. 3. 3. The interjoint fat depots and the bone marrow of the epiphyses are the source of fat in the aspirated fluid. 4. 4. The fat indicates an injury of the interjoint structures (crucial ligaments and semilunar cartilages) alone or combined with fracture of the articular surfaces. 5. 5. Fat particles torn and deposited in the joint cavity may be organized and form loose bodies. 6. 6. Early aspiration is indicated.

Summary1. Growth of human and animal synovial membrane in tissue cultures showed characteristic differences from control cultures of periarticular tissues. 2. Presence of hyaluronic acid in about two-thirds of supernates of tissue cultures from synovium was demonstrated by precipitation reactions with acetic acid, enzymatic reactions, viscosity determination, tests for metachromasia and electrophoretic patterns. 3. Quantitative determinations by a turbidimetric method yielded a concentration of hyaluronic acid from 4 to 15 mg %. 4. Tests were negative for sulfonated mucopolysaccharides such as chondroitin sulfuric acid or heparin. 5. Control cultures of periarticular connective tissue were negative for hyaluronic acid and sulfonated mucopolysaccharides.

Lewin and Wassen 1 have recently reported striking, immediate amelioration in 9 cases of rheumatoid arthritis after intramuscular injection of 5 mg. of desoxycorticosterone acetate followed by intravenous or intramuscular injection of 1,000 mg. of ascorbic acid. The effects consisted of alleviation of pain, increase of range of motion, elevation of skin temperature around the joints and decided exhilaration in some patients. As a rule the effect lasted two to six hours, occasionally more than twenty-four hours. In more acute cases improvement lasted as long as three weeks. The possibility that a hormone and vitamin combination, readily available at reasonable cost, may approach the effect of the rare and costly cortisone or pituitary adrenocorticotropic hormone (ACTH) has stirred up great interest here and abroad. Within five weeks after this preliminary report was made, seven communications 2 appeared in the Lancet . Three investigators enthusiastically supported the claims of Lewin and Wassen.

Ecchymosis during prolonged steroid therapy is most likely due to the fragmentation of elastic staining fibers, the elastotic degeneration of the collagen fibers, and their absence in the pericapillary spaces as a result of corticosteroids.

The conception of the synovial membrane as an endothelium or epithelium designed to secrete the synovial fluid was challenged by Hueter 1 in 1866. By the method of silver impregnation he demonstrated interspaces between the synovial cells filled by collagenous fibers which, in some places, covered the upper surface of the membrane. After thirty years of controversy, Hueter's views were brought to general rocognition by Braun 2 and Hammer. 3 The majority of recent investigators regard the synovial membrane as a modified connective tissue. This theory, however, makes the origin of the synovial fluid problematical. Of the various explanations advanced, none is supported by sufficient evidence. This study deals with the phenomena of precipitation, the viscosity, the specific gravity and the mucinous substance of synovial fluids. Different fractions were separated and analyzed. By correlation of the data, an effort was made to determine the source and composition of the synovial

Recent investigations have emphasized the significance of disturbances of the peripheral circulation in the etiology of conditions of the joints and muscles. In 1909, Wollenberg,1on the basis of arteriosclerotic changes in the affected joints, advanced the theory of the vascular origin of osteo-arthritis; he experimentally produced overgrowth of the patella by a circular ligation of the blood vessels. The experiment was recently repeated and confirmed by Goldhaft2and his co-workers, who had previously demonstrated, in studies of the blood flow, blood gases, capillary microscopy and surface temperature, a deficiency of peripheral circulation in arthritis. Hench, Henderson, Rowntree and Adson,3of the Mayo Clinic, reported good results in rheumatoid arthritis with ramisection and sympathetic ganglionectomy, which eliminated the vasoconstriction. Von Papp4stated that a spasm of the arterioles produces myalgia. The beneficial effect of physical therapy in rheumatic infections is also considered to be due chiefly

The systemic phase of arthritis and rheumatic conditions has been overemphasized in recent papers, with the result that comment revolved mainly around tonsils, teeth, the gastro-intestinal tract and other possible foci of infection. Expositions have been presented of conflicting bacteriologic and serologic findings, of constitutional and endocrinologie hypotheses and, finally, of rigorous and often unbalanced diets. Little has been said about the joints, and still less is done for the joints in the management of arthritis. A patient recently appraised the situation truthfully: "Why, you are the first doctor who ever looked at my knees! They pulled my teeth, took out my tonsils and gave me shots and diets, but they never bothered about my knees." As a result of her treatment this woman has a flexion contraction of both knees of 90 degrees and is totally crippled. With a little attention to the joints and with simple appliances this

Generalized adiposis dolorosa is not common, but it is not easily overlooked on account of the universal distribution of the tenderness of the deposits of fat. Localized hypersensitivity of the fat tissues, on the other hand, is common and often remains unrecognized because it is not looked for or is misinterpreted. The following report concerns a study of cases of localized tenderness of fat around the joints in 112 patients, who were observed within the last six years. DEFINITION AND SYMPTOMATOLOGY I apply the term juxta-articular adiposis dolorosa to accumulations of subcutaneous fat around the joints, which are markedly tender to touch or pressure and are not connected with gross alterations of the sensitivity of the overlying skin. The condition occurs most frequently in obese women past middle age. It is usually bilateral, although one side may be affected more than the other. The distribution is characteristic. Most frequently the

Among the many phenomena associated with arthritis and rheumatoid conditions nodular involvements of the skin compose an interesting group. Frequently some of the nodules resemble those seen in other conditions, so that the appearance of such masses is not always conclusive proof of a rheumatic etiology. Therefore, a careful differential diagnosis is essential. REPORT OF CASE History. —On March 14, 1932, a Jewish woman, aged 50, presented herself at Dr. Finkelstein's clinic. Four weeks before, while bathing, she discovered four lumps over the buttocks. The lumps were hard, painless and somewhat movable. In 1928 a falling piece of ceiling struck the patient on the head. Examination at that time failed to reveal any injury. The pain disappeared after the application of an ice-bag. In 1929 she complained of a chronic cough and nervousness. At that time a few dry râles were heard in both lungs. Her blood pressure was 160

The occurrence of hemorrhagic effusion into the knee joint due to xanthoma is very uncommon. In a review of the literature only five cases have been reported. In view of the extreme rarity of this condition we are reporting the following case. REPORT OF CASE History. —W. M., aged 23, white, American born, a garage hand, was admitted to the service of Dr. Harry Finkelstein, Hospital for Joint Diseases, New York, on March 7, 1932, suffering from a painful swelling of the left knee, which had increased in size during the past two years. There was no history of trauma. He had had occasional pain in the shoulders since the age of 13. He had gonorrhea in 1930, for which he received treatment and was discharged as cured. Appendectomy was performed in 1920. His parents and one brother and sister were in good health. There was no family history of

Estimating the specific gravity of a few drops of urine has always been a difficult problem. This difficulty arises more particularly during ureteral catheterization, when only a few drops of urine can be obtained. By the method described here, the specific gravity of a few drops of urine from each kidney can be determined. It will be found applicable in estimating the specific gravity of small samples of voided urine. This method for the determination of the specific gravity of urine is made possible by the utilization of a non-water-soluble mixture. We use for this purpose a mixture of a high specific gravity chemical (carbon tetrachloride), and a low one (xylene). It can be prepared quickly and cheaply from materials ordinarily at hand in the laboratory. Hammerschlag 1 has adapted this principle to determine the specific gravity of blood. But he has used a mixture of chloroform and benzine.

The differential diagnosis between effusions of inflammatory and of traumatic origin is important from both a medical and an economic aspect; it guides therapeutic measures, and decides, in industrial and liability cases, the claim for compensation. The conclusion is based on the anamnesis, the objective signs of injury or infection and the character of the aspirated effusion. The anamnesis can be misleading; minor injuries as well as infections are liable to be overlooked. On the other hand, the history of an accident will be questioned unless supported by clinical observations, especially in cases that involve financial liability. Abrasions, lacerations and other external symptoms are absent in a large number of traumatic effusions of the joints. Roentgenograms are positive only in the presence of intra-articular fractures. The character of the aspirated fluid is therefore the most valuable aid in these diagnostic problems. It is generally recognized that a hemorrhagic fluid indicates

It is nearly forty years since Poncet 1 described a type of tuberculous polyarthritis which resembles clinically an acute or chronic nonspecific articular disease, especially rheumatic fever or rheumatoid (atrophic) arthritis. The existence of such an entity is still controversial. The following case is among very few in which the tuberculous causation was verified by histologic examination and culture of the articular tissues. Numerous consultations in the United States and abroad reveal the differences and difficulties of interpretation and permit an analysis and evaluation of the conceptions of "tuberculous rheumatism." REPORT OF CASE Mrs. B. R. S., a Jewess aged 34, a teacher, first consulted us in May 1936 for pain in various joints and swelling and contracture of the left knee which had developed during a period of four years. Past and Family History. —In childhood the patient had some of the febrile diseases and also "rheumatic" pains of

Synovial fluids show marked differences of suspension stability. Some are rendered clear by short centrifugation, while others still contain corpuscles after prolonged action of the centrifuge. This is suggestive of differences in composition, and an investigation appeared to be pertinent from a theoretical and a clinical point of view. The value of the sedimentation rate of blood corpuscles in plasma for the differential diagnosis of arthritis is limited by the interference of various factors. By simultaneous estimation in the synovial fluid, it was hoped to eliminate some nonspecific elements and to increase the diagnostic value of the sedimentation speed in arthritis. This program required a method of suspending an amount of corpuscles in synovial fluid equal to that in blood and a suitable technic for the comparative sedimentation test. TECHNIC Preparation of the Suspension of Blood Corpuscles in Synovial Fluid. —Into a graduated centrifuge tube is put 2 cc. of

Radio short wave and ultra-short wave apparatus is now extensively advertised and has begun to replace diathermy. At the high frequencies generated by these machines, ranging from ten to a hundred million oscillations per second (equal to wavelengths of from 3 to 30 meters), it is not necessary to apply the current directly to the body through metal electrodes as in diathermy. It is sufficient to place the part to be treated in the electrical field between insulated plates. Heat is generated chiefly by displacement currents within the tissues, which act as a dielectric. This mode of application conveys the impression that the danger of burns is eliminated. The simplicity and safety of short wave therapy is played up in the sales campaign. Nothing is more erroneous. Burns have been observed clinically and they have been produced experimentally. This report warns of the great danger ahead and, it is hoped