540 DISEASES OF THE ORGANS OF LOCOMOTION. 



hardening process by washing in cold water, cold bathing in rivei or 

 sea, regular walks in all kinds of weather, etc., in the latter, all op- 

 portunities of catching cold should be avoided, the sea and river baths 

 forbidden, and the patient should be advised to wear flannel next 

 the skin. If the sleeping-room be dark and damp, we cannot too 

 strongly urge its exchange for a healthier and drier one. 



C HAPTER III. 



DEFORMING ARTICULAR INFLAMMATION, ARTHRITIS DEFORMANS, AR- 

 THRITIS NODOSA, ARTHRITIS PAUPERUM, ARTHRITE CHRONIQUE 

 SECHE. 



ETIOLOGY. By arthritis deformans, we mean those forms of artic- 

 ular inflammation where not only the synovial capsule and ligaments 

 of the joint exhibit the signs of a chronic inflammation having no ten- 

 dency to suppuration, but where, at the same time, the cartilages and 

 surfaces of bone in the joint show peculiar changes characteristic of 

 this form of arthrophlogosis. The latter consist chiefly of a loss of 

 the articular cartilage and surface of the bones, and in a central indu- 

 ration of the epiphyses, accompanied by a proliferation of bone-sub- 

 stance at the periphery. Arthritis deformans is by some authors re- 

 garded as a peculiar form of chronic articular rheumatism, while others 

 consider it as essentially different from the rheumatic affections. From 

 the great elasticity of the term rheumatism, one view is as correct as 

 the other. Arthritis deformans has at least this in common with the 

 rheumatic inflammation of the joints described in the last chapter ; it 

 cannot always be traced to catching cold from living in damp places 

 exposed to draughts. Arthritis deformans never occurs during child- 

 hood. Solitary cases are seen about the age of puberty ; it is most 

 frequent between the twentieth and fortieth years ; but it also occurs 

 later in life, and even in advanced age. It attacks women more fre- 

 quently than men. It is so much more common among poor people 

 than among the wealthy, that it has been termed arthritis pauperum. 

 We do not know whether this depends on the bad, damp dwellings, on 

 the want of good nourishment, or on some other causes to which the 

 poor are more exposed than are the well-to-do classes. 



ANATOMICAL APPEARANCES. On anatomical examination of the 

 swollen, misshapen joints, we find the articular capsule decidedly 

 thickened and covered with ragged proliferations. The joint contains 

 a very small amount of synovia (hence the name arthrite chronique 

 sbche). The articular cartilages are broken down into filaments, occa- 

 sionally ossified, and in advanced cases they have entirely disappeared 



