476 THE TREATMENT OF DISEASES. 



and redness. In this complaint the profuse sweating which is so prominent & 

 symptom of rheumatic fever is entirely absent, and the inflammation exhibits 

 no tendency to fly from joint to joint, or to attack the heart or its membranes. 



Rheumatic gout, as we have seen, is not a disease which is confined to any 

 particular age. It sometimes occurs in children of from ten to twelve, and 

 has been known to commence in very old people, above seventy. It is 

 commonly thought that women are more likely to be attacked than men, and 

 it is a recognised fact that any irregularity in the menstrual functions 

 predisposes to its occurrence. It is not hereditary, a point in which it differs 

 very markedly from gout. Everything which causes debility, or loss of tone 

 in the system, as, for example, an attack of bleeding from the womb or else- 

 where, deep or prolonged grief, or severe or protracted mental anxiety, acts as a 

 predisposing cause of the disease. It is said in some cases to have resulted 

 from rapid child-bearing, and from over-suckling. Cold is frequently an 

 exciting cause, particularly if comomed with depression of the functions of the 

 nervous system. Malt liquors and wines exert no influence on its production. 



It is of the greatest importance to be able to recognise the nature of the 

 disease in cases of rheumatic gout, for upon its correct understanding often 

 depends the future comfort and physical well-being of the unfortunate sufferer. 

 It is often, too often, mistaken either for gout or rheumatism. From an 

 attack of acute gout it may be distinguished by the duration of the complaint, 

 by the large and small joints being equally attacked at the onset, by the 

 great toes not being specially involved. Rheumatic gout is a progressive 

 disease; it has no intermissions, for during the whole of the patient's life the 

 nodes go on gradually enlarging, and impeding more and more the motions of 

 the limb. The malady spreads from joint to joint without any alleviation 

 in those which have been once attacked. In very chronic cases it is often 

 only from the history of the onset that one is able to distinguish gout from 

 rheumatic gout. In chronic rheumatism one seldom meets with the distortion 

 of the joints which is so characteristic of the complaint now under consideration. 



"We must now consider the best method of treating this disease. It must 

 always be borne in mind that it is a very intractable disease, and that in many 

 cases all treatment proves unavailing. The most favourable cases for treatment 

 are naturally those in which the disease is not far advanced, the affected joints 

 few in number, and their mobility but partially interfered with. When treatment 

 is resorted to quite at the commencement of the complaint, the disease may 

 sometimes be eradicated from the system and a complete recovery may be the 

 result. 



In all cases a sustaining plan of treatment is imperatively demanded. All 

 lowering treatment tends materially to increase the rapidity and severity of 

 the disease. Colchicum, which does so much good in gout, is worse than 

 useless, hence the importance of distinguishing between the two diseases. 

 Everything that can be done should be done to support the strength of the 

 patient. If the disease has been caused by loss of blood, and there is anaemia, 

 the different preparations of iron are earnestly called for. A selection should 



