[Constitutional diseases 315]

Chronic Type.—­There is a gradual onset of pain or stiffness in one or more joints, usually of the fingers, then of the corresponding joints of the other side and then other joints.  The swelling at first may be in the soft parts of the joints with effusion in the joints and tenderness.  The pain varies from slight to severe.  Periods of improvement and getting worse alternate; the joints becoming enlarged and deformed, often nearly stiff in partial bending on account of the thickened bone and soft tissues.  The muscles that move the joint dwindle and there may be changes in the skin and nails of the parts affected due to the want of proper nourishment.  Disturbances of the stomach and anemia are common.  The heart is not affected.  There may be only a few joints affected, or many, with great deformity, before the disease reaches the period of inactivity.

2.  Monarticular or one joint type.—­This usually occurs in males over fifty; one joint or a few large joints may be affected, generally with shrinking of the corresponding muscles.  If it occurs in the hip it is called Morbus Coxae Senilis,—­Hip joint disease in the aged.

Recovery.—­The disease usually goes on with intervals of improvement and often results in great crippling and disability.  In some cases it becomes permanent.

General Treatment.—­The climate should be warm and dry.  The patient should avoid exposing himself; lead a general hygienic life, with as nourishing food as his digestion will permit.  The chief line of treatment should be to improve the general health and relieve the pain.  The stomach, bowels, and kidneys should be kept working well.  Nourishing food should be taken, but its effect must be watched.  Cod-liver oil to build up the system, iron and arsenic may be of value.  Sometimes iodide of potash is good.  Early and thorough treatment at Hot Springs offers the best hope of arresting its progress, the Hot Springs in Bath County, Va., and in Arkansas.  Much can be done at home by hot air baths, hot baths, and compresses at night to the tender joints.

Local.—­Massage carefully given is helpful.  The hot air treatment is good.  Baking the joints is now frequently done.

Gout (podagra).—­A disorder of nutrition characterized by excess of uric acid in the blood, attacks of acute arthritis (inflammation of joints) with deposit of urate of sodium in and around the joints; with various general symptoms.

Causes.—­Heredity; male sex, usually appears from thirty to fifty and rarely under twenty; from continued use of alcoholic liquors, especially fermented, with little or no exercise; too much meat.  Unhygienic living with poor food, and excessive drinking of ale and beer may be followed by the “poor man’s gout.”  It is common in lead workers.