536 DISEASES OF THE ORGANS OF LOCOMOTION. 



the other hand there are numerous cases where such a predisposition 

 is acquired. First among the predisposing causes are previous attacks 

 of acute articular rheumatism, for after these there often remains a 

 peculiar tendency to the chronic form which did not previously exist. 

 The same is true of one or more attacks of chronic articular rheuma- 

 tism, as this also usually leaves behind a so-called rheumatic predispo- 

 sition. The most frequent exciting cause is catching cold, but espe- 

 cially a protracted sojourn in cold, damp, and windy places. Thus 

 almost all old wash-women suffer from chronic articular rheumatism. 

 In many cases the exciting cause cannot be determined. 



ANATOMICAL APPEARANCES. In the comparatively rare cases 

 where we have an opportunity to examine joints that have been the 

 seat of chronic articular rheumatism, we generally find the synovial 

 capsule and the ligaments of the joints thickened, the fringe-like pro 

 cesses of the membrane hypertrophied, and not unfrequently degener- 

 ated, the cartilages relaxed and shaggy, the synovia is cloudy. 



SYMPTOMS AND COUKSE. Chronic articular rheumatism appears 

 under two different forms. In the first form, single joints are often for 

 months or years the seat of constant pain. This is increased by press- 

 ure, but particularly by active or passive motion, and there are also 

 severe paroxysms of pain which apparently come on spontaneously, 

 especially at night. If we place the hand on the joint in motion, we 

 often perceive a distinct crackling or crepitation. Occasionally the 

 joints are decidedly swollen ; but the swelling does not depend on in- 

 flammatory oedema of the subcutaneous tissue, as is the case in acute 

 articular rheumatism, but entirely on an increase of the synovia in the 

 joints, and on thickening of the capsule and ligaments. In other 

 3ases there is no swelling, as there is no considerable effusion in the 

 joint, or else the swelling is only apparent ; the joint becomes more 

 prominent, because the muscles are atrophied on the affected limb, 

 which is always less used. Where this form lasts a long time, in- 

 2omplete, false anchyloses are readily developed ; but it rarely leads 

 to tumor albus, or arthrocace. The second form of chronic articu- 

 lar rheumatism consists mainly of a series of attacks of acute artic- 

 ular rheumatism, occurring at short intervals, in which certain joints 

 are always affected. Persons suffering from this form often become 

 " rheumatic " at every change of the weather, every time they are ex- 

 posed to a draught, and just as often without any perceptible cause. 

 Sometimes one joint is affected, sometimes another; it is slightly 

 swollen, very sensitive to pressure, but particularly painful when 

 moved. The fever, which is almost always present, is evinced by con- 

 tinued frequence of pulse, constant perspiration, by thick sedimentary 

 urme, as well as by the gradually increasing apathy and emaciation 



