DEFORMING ARTICULAR RHEUMATISM. 



541 



by wasting away, so that the ends of the bones come in contact, and 

 have smooth, articular surfaces. As a result of inflammatory atrophy 

 the central parts of the epiphyses appear porous, while their size is 

 decidedly increased, either regularly or in warty protuberances, by the 

 formation of osteophytes. 



SYMPTOMS AND COURSE. Arthritis deformans results from acute 

 articular rheumatism much less frequently than the above-described 

 chronic inflammation does ; in most cases it develops slowly, and grad- 

 ually reaches its height. A halt sometimes occurs in its progress, but 

 never a retrogression or a disappearance of the existing deformity. 

 At the commencement of the disease the patients complain of pain in 

 the affected joints ; this is usually slight, but is sometimes so severe as 

 to rob them of sleep. The pain is increased by pressure, and still 

 more by movement of the v joint ; if the hand be laid on it, we may al- 

 most always perceive a crackling or crepitation. The affected joints 

 seem decidedly thicker ; the skin covering them is of normal color, or 

 slightly reddened. The above changes most frequently affect the joints 

 of the hand and feet, especially those of the fingers, toes, and the 

 metacarpal and metatarsal articulations, but they may also attack any 

 of the other joints of the body and even the spinal column. Cases 

 where the patient is confined to his bed for years, or sits up during the 

 day in an arm-chair and at night is carried to bed, may be found in al- 

 most any large poor-house. The laity usually call this state being 

 " drawn up by the gout." The symmetrical appearance and progress 

 of the disease on the two sides of the body are often very remarkable. 

 It is rare for one hand to be affected first, and the other one subse- 

 quently ; the process is apt to begin simultaneously in both hands, and 

 to pass to the two feet at the same time. Characteristic subluxations 

 almost always occur in the affected joints, especially in the fingers ; 

 these are hardly explained by the widening of the epiphyses over 

 which the tendons pass, by the destruction of the articular cartilages, 

 and the smoothing off of the bony surfaces of the articulation. The 

 phalanges are almost always flexed on the metacarpal bones, and are 

 at the same time deviated toward the ulnar sides, so that the fingers 

 lie over each other like the shingles in a roof. In the phalanges them 

 selves the subluxations are sometimes in the flexed, sometimes in the 

 extended position, in the different joints. Patients with this tedious 

 disease may attain very old age. It is remarkable that, in spite of the 

 long duration, there is rarely complete anchylosis. The above process 

 sometimes occurs exclusively in the hip-joint, and then either induces a 

 wearing off of the head of the bone, or the formation of large stalac- 

 tite-like osteophytes, about its periphery. This disease, called malum 

 soxce senile, belongs to surgery. 



