PERSONAL APPEARANCES IN HEALTH AND DISEASE. 4! 



But the inflammations set up by diseases such as 

 rheumatism and gout, are definite in their characters, 

 are productive of great alteration in the form of the joint, 

 and may lead to changes of a permanent or chronic 

 character. Let us watch the course of an attack of 

 rheumatic inflammation, say of the knee, in so far as it 

 causes changes of form.* The pain which foretells and 

 which indicates the seat of the affection is soon accom- 

 panied by perceptible swelling; there is a rounded fulness 

 of the knee, and if the synovial sac, as often happens, has 

 a large quantity of fluid secreted into it, it is specially dis- 

 tended, and bulges beneath and on each side of the knee- 

 cap. The surface is slightly reddened, a redness which 

 fades on the least touch, under the pressure of the finger. 

 Or the ankle also may be attacked, and the bony pro- 

 jections on each side of it, which are formed by the 

 lower ends of the two bones of the leg, are concealed 

 in the pufrlness and smoothness of the inflamed tissues. 

 And here may be mentioned the fact, not, however, without 

 very many exceptions, that the larger or middle-sized 

 joints, such as the knee, ankle, wrist, and elbow, are 

 more liable to be inflamed and swollen in acute rheuma- 

 tism than other joints. Still frequently enough the 



* It must be distinctly understood that the purpose of this little book 

 is not to give full details of the symptoms of any disease, except in so 

 far as any change in the normal form is brought about by the disease. 



