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February 9, 1918


Author Affiliations

Associate Professor of Orthopedic Surgery, New York Post-Graduate Medical School and Hospital; Associate Attending Orthopedist, Mount Sinai Hospital; Assistant Surgeon, Hospital for Ruptured and Crippled NEW YORK

JAMA. 1918;70(6):372-376. doi:10.1001/jama.1918.02600060018009

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Until recently, the diagnosis of tuberculous joint disease was considered one of the simplest and most definite problems with which the orthopedic surgeon is confronted. It is evident, however, from the gradual elimination from this classification of such conditions as Perthes' disease, hemorrhagic osteomyelitis (Barrie) and other benign lesions, and also from studies of congenital syphilis pursued by me during the past two years, that this simplicity is merely apparent. We have, indeed, enjoyed a sense of diagnostic security entirely unwarranted by the facts. Heretofore it has been the custom to consider as probably tuberculous those cases of articular disease characterized by a gradual onset of symptoms, the presence of spasm on passive movement, limitation of motion in all directions, atrophy and limp, if a weight bearing joint was involved, or alteration of attitude when the lesion was vertebral.

This method of diagnosis has been practiced for many decades, and

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