In the muscles decoloration of the fibres and decrease of the volume of each muscle-fibre is found, whereas the number of the fibres is not diminished.
lleherden's knots are small, rounded growths arising from the phalanges of the fingers, commonly from the third, sometimes from the second; they con sist of bony tissue and are covered by a projection of the synovial membrane; they are most frequently found in elderly individuals, but have also been noticed at the age of 40 or 50; they are of frequent occurrence in rheumatoid ar thritis, but authors of much experience declare having also observed them in cases of true gout. Neuritis and per- neuritis, with the infiltration of small round cells in the nerve-sheaths, have repeatedly been observed.
The red corpuscles of the blood are diminished in number, the haemoglobin shows a marked diminution, and there is a slight augmentation of the white corpuscles.
Prognosis.—The prognosis is rather good as regards life; but ordinarily the disease assumes a very chronic course, and it has hitherto been most rebellious to treatment, ankylosis of the affected joints being almost certain. When this affects many joints, the patient is re duced to immobility. Of late the pros pects of cure have become somewhat more hopeful, especially when modern treatment is applied at an early stage of the disease, before the pathological changes in the joints and the atrophy of the muscles have progressed too far.
The prognosis of rheumatoid arthritis is, in general, uncertain. Many cases progress to a condition of hopeless de formity and consequent helplessness, al though the general health may not be seriously impaired, and death may take place from some intercurrent affection. In others the deformity and impairment of function are limited in degree. The prognosis is not unfavorable in those cases in which the condition receives early recognition before the permanent lesions have developed. Cuvier R. Mar shall (N. Y. Med. Jour., June 19, '97).
Treatment.—The diet, as a rule, is to be nutritious and easily digestible; when fever is present suitable liquid nourish ment must be given; all the normal constituents of the food are to be repre sented in sufficient amount; in many cases codliver-oil is indicated. Stimu
lants are not so pernicious in rheuma toid arthritis as in gout, and may be per mitted if necessary. The patients must be directed not to make few and large meals, but to take food often and at regular intervals.
Woolen garments and blankets are very useful, and the patients are to be directed to avoid chills and exposure to dampness and cold. When possible, the sufferer ought to take such exercise as his forces and the state of his joints will permit; the use of pulleys, massage, and passive and active gymnastics are very useful.
In the few cases which occur as a result of acute articular rheumatism salicylic acid and its compounds—salol, salophen, etc.—will be found useful. When these fail, iodine, iodide of potas sium, and tinctura colchici are to be tried; the affected joints are to be painted with iodine or enveloped in gauze saturated with methyl-salicylate.
Lactic acid used with success in an old case of arthritis deformans. Ten drops of this drug were daily adminis tered upon an empty stomach, no food allowed for an hour and a half after ward. Zolotavine (La Med. Mod., Sept.
18, '97).
In cases of true rheumatoid arthritis the therapeutics are to be directed prin cipally against the infection by microbes and the toxins secreted by them. Reme dies capable of strengthening the forces and the vital energy of the patient are necessary. As powerful antidotes against bacterial invasion, the creasotes, naph thols, and phenols are valuable; of the drugs belonging to this group Banna tyne prefers creasot-al, and most of all the guaiacol-carbonate. Creasotal is a thick fluid, soluble in alcohol, but not in water; it has an oily taste and a rather disagreeable odor, and is given in the dose of 5 or S drops thrice a day. Guaiacol-carbonate — a white, crystal line, insoluble, tasteless and odorless powder, which in the bowels is decom posed, yielding guaiacol—is also valu able; it is given in doses of from 5 to S grains three to six times a day. The use of the drug ought to be continued for a long time and gives excellent re sults; it alleviates the pain and combats the morbid process itself. Benzosol (benzoyl-guaiacol) may also be tried.