Definition

Osler says that it is a chronic disease of the joints, of doubtful etiology. Judging from my own experience, I should say that the disease is a legitimate outcome of abuse to the digestive function in those of the gouty diathesis.

Etiology

There is more of this disease occurring between the ages of thirty and fifty than at any other time of life. Children, and young people at or before puberty, do, however, develop it. More women than men are affected with this disease, if I am to judge from my experience.

Predisposing Cause

Gouty diathesis,

Exciting Cause

Anything that will shock the system like the loss of a friend by death, sudden fright, and injury. But, of course, for these exciting causes to precipitate a case of arthritis deformans, the patient's nutrition must be perverted, so that only the last straw, so to speak, is necessary. Some medical writers are inclined to recognize the disease as, originating in the nervous system. There is a type of arthritis deformans that has its origin in the nervous system, but it is not what is generally understood as this disease; that is, the type that distorts the joints by ankylosis (bony union). All diseases have an element of nerve derangement. Indeed, we must have enervation before any disease can develop and enervation may be brought about by anything--any influence--that uses up nerve energy.

The nutritional disturbance that ends in the disease under consideration comes from continual overeating--eating beyond the digestive capacity. The subjects in this particular class, if they were of the scrofulous diathesis, would develop tuberculosis, or some form of tubercular disease of kidneys, brain, liver, etc.; but in the gouty diathesis the disease leads off to bursal inflammations, with deposits of lime. When the morbid state is once set in motion, it will never stop until all foods that are carrying much mineral--lime, etc.--are left out of the dietary.

Symptoms

Sometimes the disease will start in the hands, sometimes in the toes; there will be a development of nodes; the finger joints become sensitive, swollen, and little elevations of bony deposits take place. If the subject moves to another country--goes from north to south, south to north, east to west, or west to east--some habits will be dropped, which may favorably influence nutrition, and the disease may come to an end, leaving the finger joints enlarged. But when the disease once starts, if the cause is not removed, accidentally or otherwise, the joints become more and more deformed, and more and more of the joints become involved in the disease, extending from the hands to the wrists and elbows, and from the toes to the ankles and knees. Sometimes the disease develops very rapidly in the spinal column, and may cause complete ankylosis in a few months. Patients who have this disease develop in the hips will often in a very short time develop ankylosis of the hip joints. This disposes forever of the possibility of sitting down--the patient must either lie down or stand up. If the knees are involved, so that there is complete loss of the knee joints, it will be impossible for the person to walk. If his arms are left to him, he may go from place to place on crutches.

No one ever has a node form on the fingers who has not had indigestion. No one will ever develop rheumatism of any kind without first having indigestion, and that indigestion must have been running along for months, and even years, before the nutrition is so perverted as to change the function of cell development. As stated above, the disease may start and come to a sudden end. Then again it may start and continue making new conquests from month to month--perhaps not so rapidly, but surely from winter to winter; each new involvement meaning a destruction of the particular joint involved. This is called the progressive type of the disease; which does not mean anything, except that nothing has been done by well-directed treatment to stop the progress of the disease by correcting the errors of nutrition.

Diagnosis

In the very beginning this disease may be mistaken for inflammatory rheumatism. This mistake will not be of long duration; for deposits will take place, which speak for themselves. The swelling is never so great in this disease as in inflammatory rheumatism. The inflammation never runs so high, and the general fever never reaches the height that it does in acute articular rheumatism.

Treatment

A lost joint is lost forever, but the disease may be checked. A complete fast should be given until the pains are all gone, and then a diet for several weeks of fruit and vegetables--fresh or uncooked fruit and non-starchy vegetables, with plenty of salad. These are the eliminating foods. Foods that are inclined to cause deposits in the system--such as meat and all forms of cereal--should be left out of the dietary, if necessary for a year, so as completely to transform the: nutrition of the victim of this disease.