ted over with
plaster of Paris. As a result of this uratic infiltration, the cartilage
loses its vitality and crumbles away, leading to the formation of what
are known as gouty ulcers, and these may extend through the cartilage
and invade the bone. The deposit of urates in the synovial membrane is
attended with effusion into the joint and the formation of adhesions,
while in the ligaments and peri-articular structures it leads to the
formation of scar tissue. The metatarso-phalangeal joint of the great
toe, on one or on both sides, is that most frequently affected. The
disease is met with in men after middle life, and while common enough in
England and Ireland, is almost unknown in hospital practice in Scotland.

The _clinical features_ are characteristic. There is a sudden onset of
excruciating pain, usually during the early hours of the morning, the
joint becomes swollen, red, and glistening, with engorgement of the
veins and some fever and disturbance of health and temper. In the course
of a week or ten days there is a gradual return to the normal. Such
attacks may recur only once a year or they may be more frequent; the
successive attacks tend to become less acute but last longer, and the
local phenomena persist, the joint remaining permanently swollen and
stiff. Masses of chalk form in and around the joint, and those in the
subcutaneous tissue may break through the skin, forming indolent ulcers
with exposure of the chalky masses (_tophi_). The hands may become
seriously crippled, especially when the tendon sheaths and bursae also
are affected; the crippling resembles that resulting from arthritis
deformans but it differs in not being symmetrical.

The local _treatment_ consists in employing soothing applications and a
Bier's bandage for two or three hours twice daily while the symptoms are
acute; later, hot-air baths, massage, and exercises are indicated. It is
remarkable how completely even the most deformed joints may recover
their function. Dietetic and medicinal treatment must also be employed.

#Chronic Rheumatism.#--This term is applied to a condition which
sometimes follows upon acute articular rheumatism in persons presenting
a family tendency to acute rheumatism or to inflammations of serous
membranes, and manifesting other evidence of the rheumatic taint, such
as chorea or rheumatic nodules.

The changes in the joints involve almost exclusively the synovial
membrane and the ligaments; they consist in c