[Illustration:  FIG. 164.—­Charcot’s Disease of both Ankles:  front view.  Man, aet. 32.]

The disease may become arrested or may go on to complete disorganisation; suppuration may ensue from infection through a breach of the surface, and in rare cases the joint has become the seat of tuberculosis.

[Illustration:  FIG. 165.—­Charcot’s Disease of both Ankles:  back view.  Man, aet. 32.]

Treatment, in addition to that of the nerve lesion underlying the arthropathy, consists in supporting and protecting the joint by means of bandages, splints, and other apparatus.  In the lower extremity, the use of crutches is helpful in taking the strain off the affected limb.  When there is much distension of the joint, considerable relief follows upon withdrawal of fluid.  The best possible result being rigid ankylosis in a good position, it may be advisable to bring this about artificially by arthrodesis or resection.  Operation is indicated when only one joint is affected and when the cord lesion is such as will permit of the patient using the limb.  The wounds heal well, but the victims of tabes are unfavourable subjects for operative interference, on account of their liability to intercurrent complications.  When the limb is quite useless, amputation may be the best course.

In cerebral lesions attended with hemiplegia, joint affections, characterised by evanescent pain, redness, and swelling, are occasionally met with.  The secondary changes in joints which are the seat of paralytic contracture are considered with the surgery of the Extremities.

In cases of hysteria and other functional affections of the nervous system, an intermittent neuropathic hydrops has been observed—­especially in the knee.  Without apparent cause, the joint fills with fluid and its movements become restricted, and after from two to eight days the swelling subsides and the joint returns to normal.  A remarkable feature of the condition is that the effusion into the joint recurs at regular intervals, it may be over a period of years.  Psychic conditions have been known to induce attacks, and sometimes to abort them or even to cause their disappearance.  Hence it has been recommended that treatment by suggestion should be employed along with tonic doses of quinine and arsenic.

HYSTERICAL OR MIMETIC JOINT AFFECTIONS

Under this heading, Sir Benjamin Brodie, in 1822, described an affection of joints, characterised by the prominence of subjective symptoms and the absence of pathological changes.  Although most frequently met with in young women with an impressionable nervous system, and especially among those in good social circumstances, it occurs occasionally in men.  The onset may be referred to injury or exposure to cold, or may be associated with some disturbance of the emotions or of the generative organs; or the condition may be an involuntary imitation of the symptoms of organic joint disease presented by a relative or friend.