thirty and fifty-five. The cause is still a matter of doubt,
although it often follows, or is associated with, nervous diseases,
and in other cases the onset seems to be connected with the existence
of influenza or gonorrhea, so that it may be of germ origin. Constant
exposure to cold and dampness, excessive care and anxiety, and injury
are thought to favor the disease. The disease is sometimes limited to
the smaller joints of the fingers and toes, little, hard knobs
appearing on them. At times the joints may be swollen, tender, and
red, and are usually so at the beginning of the disease, as well as at
irregular intervals, owing to indigestion, or following injury. At
first only one joint, as of the middle finger, may be attacked, and
often the corresponding finger on the other hand is next affected.
The joints of the fingers become enlarged, deformed, and stiffened.
The results of the disease are permanent so far as the deformity is
concerned and the stiffness which causes interference with the
movement of the finger joints, but the disease may stop during any
period of its development, leaving a serviceable, though somewhat
crippled, hand. In these cases the larger joints are not generally
involved. There is some evidence to indicate that this form of the
disease is more commonly seen in the long-lived.

=General Form.=--In this type the disease tends to attack all the
joints, and, in many cases, to go from bad to worse. The hands are
usually first attacked, then the knees, feet, and other joints. In the
worst cases every joint in the body becomes diseased, so that even
movements of the jaw may become difficult. There are at first slight
swelling, pain and redness about the joints, with tenderness on
pressure. Creaking and grating are often heard during motion of the
affected joints. This condition may improve or subside for intervals,
but gradually the joints become misshapen and deformed. The joints are
enlarged, and irregular and stiff; the fingers become drawn over
toward the little finger, or bent toward the palm, and are wasted and
clawlike. The larger limbs are often bent and cannot be straightened,
and the muscles waste away, making the joints look larger. In the
worst cases the patient becomes absolutely crippled, helpless, and
bedridden, and the joints become immovable. The pain may be great and
persistent, or slight. Usually the pain grows less as the disease
advances. Numbness and tingling of the skin ofte