RHEUMATIC GOUT. (Rheumatic Arthritis. Arthritis Deformans).--Cause.--It
occurs most often from thirty to fifty-five, usually in women, generally
at or after the change of life, and most frequently in those who have not
had children. The involvement of the joints is most common in adult males.
Exciting cause may be: Exposure to cold and wet, improper food, unhygienic
surroundings, worry, blows and acute infections.
Conditions.--Several joints are usually involved symmetrically. At the
edge of the joints there is formation of new bone covered with cartilage,
causing the enlargement of the bone and often partial loss of motion in
that joint.
Symptoms.--Several distinct types exist. 1. General progressive types
which may be acute or chronic.
Acute.--This occurs usually in women from twenty to thirty and at the
change of life. It comes on like acute joint rheumatism, many joints being
affected, permanent enlargement appearing early, redness of the joints
rarely existing, the pain being very severe, some fever, feel very tired,
with anemia, loss of flesh and strength. The first and later attacks are
often associated with pregnancy, confinement or nursing.
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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.
Symptoms. Acute Type.--There is often a period of irritability,
restlessness, indigestion, twinges of pain in the hands and feet; the
urine is scanty, dark, very acid, with diminished uric acid and deposit
when it is cooled. The attack sets in usually early in the morning with
sudden intense pain in a joint of the big toe, generally the right; less
often in an ankle, knee, wrist, hand or finger. The part swells rapidly,
and is very tender, the overlying skin being red, glazed and hot. The
patient is usually as cross as a wounded bear. The fever may be 103. The
pain may subside during the day, and increase again at night. There is no
suppuration (pus forming). The symptoms usually decrease, gradually, the
entire attack may last from five to eight days. Scaling of the skin over
the sore part may follow. After the attack, the general health may be
improved, and the joint may become normal or but slightly stiff. It recurs
at intervals of a few months commonly.
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Retrocedent Gout.--This is a term applied to serious symptoms which
sometimes go with rapid improvement of the local joint conditions. There
are severe pains in the stomach, nausea, vomiting, diarrhea, pain in the
heart, difficult breathing, palpitation, irregular and feeble action of
the heart with brain symptoms, probably from uraemia. These attacks often
cause death.
Chronic Gout, Causes, etc.--Frequent acute attacks; many joints, beginning
with the feet, become stiff and deformed, perhaps with no motion. The
overlying skin may ulcerate, especially over the knuckles. Dyspepsia,
arterio-sclerosis, enlargement of the left ventricle of the heart and a
great quantity of urine with low specific gravity are common. The patient
is morose and irritable. Eczema, chronic bronchitis, frequently complicate
the case.
Death often occurs from uraemia, meningitis, pleurisy, pericarditis or
peritonitis.
Treatment, Preventive.--Live temperately, abstain from alcohol, eat
moderately, have plenty of fresh air and sunshine, plenty of exercise and
regular hours. These do not counteract the inherited tendency. The skin
should be kept active, if the patient is robust, by the morning cold bath
with friction after it; but if he is weak and debilitated, the evening
warm bath should be substituted. The patient should dress warmly, avoid
rapid alternations in temperature, and be careful not to have thc skin
suddenly chilled.
Diet in Gout.--Most persons over forty eat too much. Eat reasonably and at
regular hours and take plenty of time to eat. Do not eat too freely of
meats and avoid too much starchy and sugary foods. Fresh vegetables and
fruits may be used freely, except cranberries and bananas.
Dr. Osler of England says.--While all stimulants are injurious to these
patients some are more so than others, particularly malted liquors,
champagne, port and a very large proportion of all the light wines. Take
large quantities of water on an empty stomach, mineral waters are no
better than others, but treatment of chronic and irregular gout at springs
gives the advantage of regular hours, diet, etc.
[Illustration: A Skiagraph (X-RAY photograph) of the hand. Made for the
purpose of locating piece of needle. Photo by P. M. Campbell, Detroit,
Mich.]