42 PERSONAL APPEARANCES IN HEALTH AND DISEASE. 



smaller joints of the fingers, and less frequently those of 

 the toes, also suffer. In a short but variable time, a few 

 days or at most a few weeks, the swelling subsides ; with 

 the subsidence of the inflammation, the joint regains its 

 natural shape and mobility. But the rheumatism may 

 become chronic, and then the swelling, although much 

 diminished in extent, will yet remain a very long time, or 

 may indeed never wholly disappear. And in this con- 

 nection we might refer to an inveterate, nay an incurable 

 and painful malady, one which never loses its hold on 

 the sufferer, but advances as it were step by step from 

 joint to joint, cramping their movements, and finally en- 

 tirely restraining them, and leading to an amount of dis- 

 vtortion and alteration in and around them which entirely 

 alters their form as well as their function. Under its 

 popular cognomen of " rheumatic gout," or its scientific 

 name of chronic rheumatic arthritis, this affection is known 

 to many. Happily of not very frequent occurrence, its 

 inveteracy is its foremost feature, an inveteracy due to 

 the slow disorganising changes to which it^leads. The 

 knuckles of the hand become rough and irregular, and the 

 small bones of the fingers are displaced from their natural 

 relations one to another. The nodular prominences 

 which occur over and above the normal outline of the 

 joint are due to the production of fresh bony substance 

 in the ligaments and from the bones around them, while 



