RHEUMATIC GOUT. 475 



In conclusion, we should wish to say one word of comfort, and that is, that 

 however bad the attack of rheumatic fever may be, and even when it is complicated 

 by heart disease, it seldom or never proves immediately fatal, and the patient is 

 almost sure to get over the illness. 



RHEUMATIC GOUT. 



The term " rheumatic gout " is one which is employed somewhat loosely both by 

 medical men and the public. It is not uncommon to hear gouty people say that they 

 are suffering from rheumatic gout, simply because the disease which for years was 

 manifested in the feet only now implicates other joints, as the elbows and hands. 

 In fact, the same malady is often regarded as gout when it is confined to the feet, 

 and as rheumatic gout when it affects the upper extremities. Sometimes the sub- 

 acute forms of rheumatism are improperly called rheumatic gout, particularly when 

 they affect the upper extremities. There is, however, a third disease which is 

 neither gout nor rheumatism, but quite distinct from both, and it is this which it is 

 our intention to discuss under the term of rheumatic gout. The ordinary technical 

 term for this complaint is "rheumatic arthritis," but it is sometimes known as 

 " nodosity of the joints." 



True rheumatic gout may occur either as an acute or as a chronic disease, but 

 as the latter form is much the more common, it is to this that our attention will be 

 principally directed. 



Chronic rheumatic gout may occur in either sex, and at almost any age. The 

 ordinary course of the disease is somewhat as follows : A young woman who is 

 decidedly out of health, perhaps as the result of over-work and confinement to the 

 house, catches cold, and after a few days experiences some pain in one of her knees, 

 and on examination slight swelling and tenderness are detected. As the result of 

 rest and judicious treatment, the pain subsides, and no more is thought of the matter. 

 A few weeks later, or it may be months, the patient catches another cold, and the 

 same or another joint is affected in a precisely similar manner. On this occasion, 

 however, treatment is apparently of no avail, and the inflammation, instead of sub- 

 siding, gradually spreads to other parts. After a time almost every joint in the 

 body may be affected, the complaint causing great distortion and deformity. These 

 changes take place slowly, and may be attended with but little disturbance of the 

 general health. In confirmed cases the hands are usually thin from the absorption 

 of fat and the wasting of the soft tissues, and the knuckles are greatly enlarged so 

 as to form big lumps, or nodes ; sometimes the fingers are so bent and distorted one 

 over another that they are, for all practical purposes, useless. The elbow in many 

 cases cannot be straightened, and the wrists are rigid, and scarcely admit of motion 

 in any direction. The knee is commonly much enlarged and rounded, and is often 

 bent with difficulty. Sometimes, in very bad cases, the patient is rendered helpless 

 and a cripple for life. 



When the disease commences in the acute form, it closely resembles rheumatic 

 fever ; several joints are attacked, the swelling is considerable, and there is 

 distinct increase in the temperature of the affected parts, with pain, tenderness, 



