PERSONAL APPEARANCES IN HEALTH AND DISEASE. 43 



the articulating surfaces of the bones gradually lose their 

 cartilaginous covering, and become slowly altered in 

 shape. In consequence of the fixing of the joints, the 

 muscles which acted on them are no longer called into 

 play, and these waste, and lead to a shrinking in the 

 bulk of the limb itself. 



The changes in shape of the joints which gout produces 

 are somewhat like those of rheumatism. (The joints 

 affected are as a rule those of the great toe, ankle, fingers, 

 but even knees, wrists, and elbows.) In the acute form of 

 gout, if it were not for the particular joint implicated and 

 collateral evidence, some difficulty might 

 first exist in determining whether the 

 joint swelling were due to rheumatism or 

 gout. The skin over a gouty joint in the 

 acute stage is glossy and shining, and when 

 the disease becomes chronic the defor- 

 mations it leads to are marked and cha- 

 racteristic. Around the affected joint 

 spring up nodulated chalky masses, which every acute 

 attack leaves behind, until hardly a joint of any limb but 

 is not deformed and rendered unsightly, and to a large 

 extent unserviceable by the disorder. ' (See Fig. 7.) 



There are of course other diseases affecting joints, than 

 either gout or rheumatism, and resulting in quite as much 



* Extreme deformity of hand in chronic gout (after Garrod). 



