the condyles of the femur. It may be months or even years before the
lipping and other hypertrophic changes in the ends of the bones are
recognisable, and before the joint assumes the deformed features which
the name of the disease suggests.

The capsular ligament, except in hydrops, is the seat of
connective-tissue overgrowth, and tends to become contracted and rigid.
Intra-articular ligaments, such as the ligamentum teres in the hip, are
usually worn away and disappear. The surrounding muscles undergo
atrophy, tendons become adherent to their sheaths and may be ossified,
and the sheaths of nerves may be involved by the cicatricial changes in
the surrounding tissues.

_The X-ray appearances of arthritis deformans_ necessarily vary with the
type of the disease and the joint affected; in the joints of the fingers
there is a narrowing of the spaces between the articular ends of the
bones as a result of absorption of the articular cartilage, and
rarefaction of the cancellous tissue in the vicinity of the joints; in
the larger joints there is "lipping" of the articular margins,
osteophytes, and other evidence of abnormal ossification in and around
the joint. Eburnation of the articular surfaces is shown by increase in
the density of the shadow of the bone in the areas affected.

[Illustration: FIG. 161.--Arthritis Deformans affecting several
Joints, in a boy aet. 10.

(Dr. Dickson's case.)]

_Treatment._--Treatment is for the most part limited to the relief of
symptoms. On no account should the affected joints be kept at rest by
means of splints or other apparatus. Active movements and exercises of
all kinds are to be persevered with. When pain is a prominent feature,
it may be relieved either by douches of iodine and hot water (tincture
of iodine 1 oz. to the quart), or by the application of lint saturated
with a lotion made up of chloral hydrate, gr. v, glycerin [dram]j, water
[ounce]j, and covered with oil-silk. Strain and over-use of the joint
and sudden changes of temperature are to be avoided. The induction of
hyperaemia by means of massage, the elastic bandage, and hot-air baths is
often of service. Operative interference is indicated when the disease
is of a severe type, when it is mon-articular, and when the general
condition of the patient is otherwise favourable. Excision has been
practised with success in the hip, knee, elbow, and temporo-mandibular
joints. Limitation of movement and locking at the hip-join