As a treatment for chronic rheumatic arthritis it is advised that the patient be chloroformed. the joints freely and fear hssly moved, and the flexors and exten sors roughly massaged. Collins (Brit. Med. Jour., Apr. 19, '90).
Heroic treatment of acute rheumatism by means of opening and draining the affected joints advocated. Operation ,hould be performed as soon as one joint is definitely affected, in order to save other joints and the endocardinin. Gen eral toxmia disappears when the af fected joints are irrigated and drained. The incision into the joint must be large encugh to admit the index-finger in order to remove the coagulated lymph. Irri gation with 1 in 5000 solution of bini odide of mercury and potassium is best. The joints should be dried with a long roll of gauze in order in drying to re move all flocculi. The joint should be drained by a gauze drain. J. O'Conor Annals of Surg., Feb., '9S).
Report of 22 cases of rheumatic and allied diseases of joints complicated by deformity. Personal experience has shown that the hot-air treatment in multiple arthritis with deformity is dis appointing. There is usually a tempo rary relief. but relapses occur. While it is difficult to fix upon any one form of treatment. the forcible breaking lip of adhesions -when inflammatory eonditions have subsided and the discriminate use of plaster of Paris have yielded the best results. Eaeli year the efficiency of absolute immobilization as a promoter of absorption of chronic inflammatory products has affirmed itself. The pro tection of joints with a limited range of motion by apparatus within the bounds of this motion is also recommended. V. P. Gibney pled. Record, Mar. 2, 1901).
Gout, Arthritis of.
Gont is certainly less common in this country than abroad. On this account it may not be recognized at first sight.
It attacks all the joints, but most quently the inetacarpo-phalangeal joint of the big toe. It may present itself in an acute form, affecting only one joint, or in a more chronic form. This latter is usually preceded by the former. So that the chronic form of the disease may be largely the remains of several acnte at tacks. The changes produced in the parts are marked, as is also at times the resultant disability. The cartilages are apt to be first attacked and then the rounding structures. I7rate of soda is deposited in the joint on the articular cartilages and through them, in the cap sular lig,aments, and even surrounding tissues. To such an extent is this latter the case that gouty nodules of urate of soda deposited on the knuckles not in frequently ulcerate throu:7h the skin.
Statistics of the location of the pain in cases of gout and rheumatism occur ring in Roosevelt Hospital.
In ail diarthritic joints the painful points in gouty inflammation were, with certain specific exceptions, on the con dyles. In acute thettinatic arthritis, on the other hand, the pain was more dif fused, but, distinctly pronounced along the tendons, and at their attachments. but not on the condyles. In rheumatoid arthritis there was no uniformity in the localization or tenderness on pressure. In gout the periosteum was chiefly affected, and in rheumatism the sub stance of the bone. W. H. Thomson (Amer. Medico-Surg. Bull., Aug. 16, '96).
The treatment of an acute attack is to be sedative, but not too depleting. This subject is fully treated under GOUT, volume iii. Surgical measures are rarely required. When the chalky deposits are marked, and, if they are loose, the skin may be incised and the deposit turned out. Care should be taken not to injure the skin over these deposits or it may ulcerate and leave an exceedingly annoy ing sinus.
Charcot's Disease.
This name is applied to the joint affections which at times accompany locomotor ataxia. Charcot estimated that they occurred in 10 per cent. of the cases of ataxia, but in this country, at any rate, the proportion is much smaller. The changes produced in the joint re semble to a considerable extent those present in osteoarthritis. The course of the affection, however, is differ ent. There are the same cartilaginous changes, with first fibrillation and then disappearance. There is a inarked in crease of synovial fluid, bulging out the joint usually more marked than in osteo arthritis, and there are the same ridges of bone, with occasional nodules. The disorganization of the joint is apt to be more rapid and more marked. Whereas a joint affected with osteoarthritis tends to ankylose, that affected with Charcot's disease becomes loose and flail-like. Pain is a marked symptom in the former: In the latter it is only present to any extent in the early stages, to be replaced later by anmsthesia. Even the bones wear away as if from pressure. It usually at tacks single joints, but both knees may be affected or the elbow and fingers. At times its course is rapid disorganization occurring in a few weeks, and this in dependently of the fact of use of the joints. These cases are of particular terest to the surgeon, because he is liable to be consulted before the ataxic disease has been recognized, and their true acter is liable to be overlooked. When ever an adult patient comes with a joint largely distended with fluid, with com paratively slight pain, and with symp toms apparently too mild for the evident destructive lesions present, then one should search for ataxic symptonas.