. The practice of medicine; a text-book for practitioners and students, with special reference to diagnosis and treatment . come cold, 784 COXS TI r U TIONA L DISEA SES and especially when accidentally struck. At other times they are insen-sitive. These nodosities have no relation to gout and are especiallycontributed by the laity to gout, but this is an error. They arequite independent of the tophaceous deposits of gout, which are alto-gether absent in arthritis deformans. Persons in whom they are per-manently present rarely have the large joints invaded, and, indeed, aresaid to have promise
. The practice of medicine; a text-book for practitioners and students, with special reference to diagnosis and treatment . come cold, 784 COXS TI r U TIONA L DISEA SES and especially when accidentally struck. At other times they are insen-sitive. These nodosities have no relation to gout and are especiallycontributed by the laity to gout, but this is an error. They arequite independent of the tophaceous deposits of gout, which are alto-gether absent in arthritis deformans. Persons in whom they are per-manently present rarely have the large joints invaded, and, indeed, aresaid to have promise of long life. Subcutaneous nodules, are also foundin arthritis deformans. (6) The Progressive Form.—This may be acute or chronic. Theacute form simulates in its beginning rheumatic fever. Among childrenboys are more frequently attacked than girls. There are swelUng of thejoints, tenderness, and fever. These may continue without materialchange for weeks, or may abate to recur with increased severity; on thewhole, however, growing worse, until the permanently enlarged and distortedstate to be described is Fig. 130.—HcbcnlLiis XMlo>ii!«.?>.From a photograph of the hand of a patient of the author. In the chronic form the same changes develop more slowly and with-out fever, maintaining with remarkable constancy a symmetrical orderof development, the order of frequency being the hands, knees, feet, ankles,wrists, elbows, shotilders, jaws, cervical spine, hips, and dorsal spine. Strik-ing changes are seen in the knees, which become enlarged and so fixed thatthe legs are constantly flexed on the thighs, and the thighs on the flexions may be contributed to by contractures, which may, however,arise secondarily, subsequent to the flexion, or form pari passu with are seen in the upper extremity as well as in the lower, producing the seal-fin deflection at the wTist and a rectangtilar bend at the elbow. Theactual enlargement is exaggerated in app
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