BILIRUBIN IN EFFUSIONS OF THE JOINTS

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