The bowels should also be regulated. For this purpose the natural or the artificial Carlsbad salts may be used. The artificial are made by combining equal parts of sulphate, phosphate, and bicarbonate of soda, of which a tea-spoonful is taken in half a tumblerful of water in the morning. Friedrichshall water or Hunyadi Janos may be taken instead of the above, a claret-glassful slightly heated being generally sufficient to produce the desired effect.
The most commonly used medicine is iodide of potassium, of which 3 grains dissolved in water may be taken thrice daily for several weeks. A mixture that has obtained great credit is made of guaiacurvy sulphur, and potash, as directed in the recipe for gout. (See Ar rENDIx or PRESCRIVrIONS.) The long-continued use of cod-liver oil is also beneficial.
This disease must be carefully distinguished from Rheumatoid Arthritis, a description of which follows.
Rheumatoid Arthritis (Arthritis Defoe mans).—This is a disease which has far a lung time been confused with chi•nie rheumatic in flammation of joints, but which differs essen tially from it.
It usually attacks women about the time of change of life. It is often associated with one or other of the diseases peculiar to women, and its commencement is frequently ascribed to anxiety or other depressing mental emotion, such as shock or fright. Several theories are in vogue to account for its production, one ascribing it to some disturbance of the nervous regulation of the nutrition of the joint, another attributing it to a toxic cause, the toxin being produced by some defect in the chemical pro cesses going on in the intestine.
Symptoms.—The disease is of slow progress, and as a rule without fever or other marked evidence. Probably the first thing noticed is the enlargement of the joints of the fingers, au enlargement attended by pain. In time mani fest deformity is produced. As a rule both hands are attacked simultaneously, similar joints of each band being involved. Following the finger joints, the knuckles become involved, then the wrist, elbows, and shoulders. A similar progress occurs when time lower extremities are attacked, as they usually are. The deformity produced by the changes going on in the joints is quite different from that exhibited by the disease with which rheumatoid arthritis is fre quently confused. For in the case of rheuma toid arthritis it is the essential structures of the joint that, from the beginning, are involved.
Degenerative changes occur in the cartilages of time joint, which end in the opposing surfaces of bone becoming denuded of their protective gristle. The ends of the bones thus exposed become dense and polished like ivory. At time same time, round the edges of the joint surfaces bony outgrowths are formed, which can be felt and seen as hard masses disposed irregularly about the joint. The position of sonic of these masses may cause locking of the joint, while the greater growth at one part of the joint may cause it to be pressed over into an abnormal position, and so permanent distortion occurs.
The muscles about the joints become wasted, adding to the deformity and difficulty of move ment.
If the bones entering into the joint can be moved on one another, a grating or cracking sound may be heard, because the ends of the bones have been denuded of theirsmooth coating.
The progress of the disease is attended by periodic outbreaks of increasing swelling and pain, which, for time time, totally cripple the patient, while neuralgic pains, muscular cramps, and spasms are frequent.
The disease is one of very slow progress, and does not itself kill, though the worry and con tinual discomfort may, by impairing the general health, render the patient a more easy prey to some other disorder.
It is most important to distinguish between this disease and that just previously described, because the latter is a curable disorder, if treatment be judiciously carried on from the beginning, while true rheumatoid arthritis is little amenable to treatment. Another reason for carefully distinguishing is, that the sub jects of rheumatoid arthritis require generous stimulating diet. Lastly, the forcible methods of breaking down adhesions in chronic rheu matic joint affections would never be adopted in rheumatoid arthritis.
If, therefore, there is any difficulty in arriv ing at a decision, time affected joints should be examined under the Roentgen rays and a photo g•aph taken. The changes in the joints them selves, which occur in the disease we are dis cussing, cannot fail to print their evidences on the photograph, while in chronic rheumatic affections, in which the soft tissues are involved, the bones will be found normal.