Rheumatic Gout.

This term is much used to denote a combination of the two
diseases, rheumatism and gout; a use which is rarely proper, since
the two diseases seldom occur in the same individual. The proper
use of the term is to designate an affection which is neither
rheumatism nor gout, but presents some of the characteristics of one or
the other, or both, of these diseases. To prevent this misunder­
standing, it has been proposed to call the disease in question -
rheumato diarthritis. This disease is either acute or chronic, usually
the latter. In the acute form, if the larger joints are affected, it
resembles acute rheumatism, though the fever is less marked, and
the joints more swollen than in rheumatism ; moreover, there is not
the same tendency to spread from one joint to another, nor is there
danger of inflammation in and around the heart. The chronic form is
distinguished, also, from rheumatism by the amount of liquid in
the affected joints, and by the tendency to destroy the ends of the
bones constituting the joints. One of the most characteristic
features is a tendency to a peculiar distortion of the fingers, which
are directed toward the outer side of the hand, and cannot be
retained in their proper position. Rheumatic gout occurs at all
periods of life, most commonly in people suffering from feeble
health. It is said to be especially apt to affect the children of con­
sumptive parents, and the offspring of gouty or rheumatic persons.
“ It fixes upon the girl just arriving at puberty, in whom the uterine
functions are not well performed ; it invades the stiffening joints of
the woman who has arrived at that time of life which is marked by
the cessation of the monthly periods ; it shows itself during the
state of debility which follows in a miscarriage or a difficult and
protracted labor, more especially when accompanied by flooding ;
it is a frequent attendant upon kidney disease, and upon the ill
health produced by syphilis, or gonorrhoea ; it is a common sequel
of prolonged suffering, of excessive venery, of severe and long-
continued mental exercise, and of mental distress and bodily
exhaustion. “—Fuller.

Treatment.—Since this disease rarely occurs, so long as the
health is kept at par, it may be laid down as a general principle,
that the first object of treatment is almost invariably the improve­
ment of the individual’s general condition. For this purpose,
hygienic measures—food, air, exercise—should be carefully regula­
ted ; and, in addition, it may be advisable to take some of the
usual tonics containing iron. There may be, of course, in every case
special circumstances which require particular attention.
The swollen joints require especial attention, not simply to
relieve the painful symptoms, but also with the hope of checking
the inflammation, so as to prevent the destructive results which often
occur in the joints. It is absolutely necessary that the joints be kept
perfectly quiet; they should be enveloped in hot cloths enclosed in
oiled silk. Sometimes advantage may be derived from the appli­
cation of the tincture of iodine to the skin; this may be painted on
with a earners hair brush or with a piece of soft rag, or small fly
blisters may be applied to the swollen joints, first on one side and
then upon the other, so as to keep up a certain amount of irritation
for several days. These measures (the iodine and the blisters) are
beneficial after the acuteness of the pain has subsided. So long as
the symptoms are violent, it will be better to keep the joints wrapped
in flannels wrung out of hot water. A considerable degree of
stiffening often persists for a considerable time, and may be relieved
by passive motion of the limbs ; that is, having them gently bent
by the attendant, and by gentle friction with some liniment, such as
the chloroform liniment.

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