Fluid in a Joint (Chronic Serous Synovitis) is a very common complaint, which every experienced practitioner has seen and treated many times.

Most of these cases have to do with the knee, and throw no light on the pathogenesis; they often occur as the result of trauma. The patient can only say that the joint gradually swelled without drawing his attention to it by causing pain. He feels a very slight disablement, merely a feeling of weight, weakness, and insecurity when using the leg. The joint appears swollen, but is not hot or red. The contour on either side of the patella is changed and the hollow under the tendon of Quadriceps Femoris, indicating the joint, is replaced by fulness. In order to ascertain whether there is any effusion present in the joint the patient's leg must be extended in a lying position. One then presses with one hand on the anterior surface above the patella and so empties the hollow under Subcrureus of its fluid contents, thereby increasing the content of the rest of the joint; then one taps the patella lightly with one hand and observes "riding" of the patella.

This frequently obstinate complaint can sometimes be cured by hard frictions on the anterior part of the capsule, effleurage over the popliteal region, and a bandage, preferably of elastic, worn as long as the joint is under treatment and for some time after recovery. In other cases the joint must be treated by aspiration, injected with a solution of carbolic or dilute iodine (1 : 3), and when the reaction has passed off must be massaged before complete recovery is obtained.

At this point I feel compelled to go into the intricate question of the distinction between chronic progressive arthritis, chronic rheumatism of joints, and arthritis deformans.*

* I have now considerable clinical experience of these cases, as I have seen them every year for over thirty years. But I will not pretend that I am therefore clear as to the various forms of these diseases. Considerable help towards a knowledge of them can be gained by the study of three recent works: "Arthritis deformans and sogenannter chronischer Gelenkrheumatismus," Albert Hoffa u. G. A. Wollenb3rg : Stuttgart, 1908; Wullstein and Wilms, "Lehrbuch d. Chirugie": Jena, 1910; and "Studier ofver rheumatiska och rheumatoida sjukdomar," by Israel Hedenius, Om spondylarthritis, Hygiea : Stockholm, 1911.