Atlanta Georgian. [volume] (Atlanta, Ga.) 1912-1939, 1913-09-21

least, knows all about the SUBJECT u you leaN
any textbook dealing with arthritis, you VIII
be clever mau If YOU know what the author
means and, on the other hand, you may PROB
ably consider hat the writer does not himself
know You will find a whole series OF diseases
inextricablv mixed up under the same name
OF different names applied to the same disease
You ind such names as rheumatod arthritis
infective arthritis toxic arthritls arthritis de-
foTmans, Osteoarthritis, chronic rheumatism
rheumatic govt, indiscriminately applied TO
variety OF affections OF the joints and to dit
ferent stages Of the same affection.
Arthritis deformans Is common name Tor
the disease with which we are dealing, but II
YOU wait for daformity before correctly dag
nosing the disease you may have 10 walt for
years until the patient is becoming a hopeless
cripple Again. some call this affection an IN
fective arthritis and others call It toxic ar
thrills without offering any proof In support OF
their contentious.
Because certain cases OF arthritis have been
associated with pyorrhoea alveolaris or an ul
Ger in the rectum. and have been cured by
vaccine It has been promptly assumed that all
cases OF rheumatoid arthritis are due to some
germ or other. or to its toxin. But such evil
dence as this is no proof whatever that these
easily remedable cases are similar in any
way allied to the chronic polyarticular infam-
nations Of the synovial membranes and peri
srticular structures of the joints which we
designate rheumatoid arthrtis
Perhaps the most popular view of this az
lection in the present day is to look upon II
as a toxic arthritis due to one or more toxins
produced by the intestinal fora. but no attempt
has been made to show the nature Of the toxin
or its special affinity for the joints, what
the liver has been doing to allow It to pass its
portals.
Osteoarthrtis Is frequently used as a syno-
nym for rheumatoid arthritis, but really tho two
conditions Numerically opposed The for.
msr usually occurs at later age; the disease
runs a very chronic course without any exacer-
bations There is thickening OF the synovial
membranes erosion Of the carriages. eburna-
ton Of the ends OF the long bones and the
formation OF osteophytes. II usually affects
many joints, but hip-joint may be the only
one involved II IS true that the deposition OF
lime salts may take place IN the nnad stages
OF rheumatod arthritis but this only occurs
after the disease ia over and the deformity
left II is Natures clumsy method OF effectng
a cure
BY process Of elimination ! am now in a
position to define what mean by rheumatoid
Rrthritis II IL a low, chronic poyarticular in.
fammRtion with frequent acute exaCerbations
There is thiCkening OF the synovial membranes
and the periarticular hbrous tissue with slight
Serious effusion into the joints The muscles
generally are wasted. irritable and contracted;
the deep reheXes are increased. and there is
frequently neuritis. especially OF the nerves sup
plying the joint structures The Joints at
first stif, grating and painful on movement.
In my experience the large joints, especially
the knees shoulders and ankles, are first IN
volved. and one Joint only may be at first az
fected, especially If 1t had been previously In.
jured
In this stage OF the disease. II recognized and
energetcally treated It rapidly disappears; but
unfortunately the disease is not then usually
diagnosed, but is called chronic subRcute
rheumatism and treated accordingly; or II Il
be recognized, the patient Is told that It will
eventually cripple her, and nothing can be done
except to try and delay its progress II the
disease be allowed to progress, as II practically
always is, then you get the smaller joints az
fected. such the wrist joints cGrpus meta
carpo-phalangeal and first phalangeal joints and
the joints of the toes You then get the char
acterstic fusiform swelling of the joints, and
OF course, die gnosis can no longer be delayed.
The further swelling Of the joints is accom-
panied by increased efusion, erosion of the car
tilages and rarefaction OF the articular ends
of the bones from absorption OF he lime salts.
From the DISCRIMINATION OF the joints and
muscular contraction you get wellmarked ar
thrills deformans II is still possible to cure the
disease. but not the deformity. H. however,
you keep hunting after the germ and its toxin,
the patient well her joints will become
q hopeless wreck.
In dealing with the nomenclature l have to
some extent referred to the etlolcgy As | be-
leve with Newton that we should admit no
more causes Of natural phenomena than such
as both true and sufficient to explain their
appearance. shall at once pass over the score
OF causes which have been set down In text
books and state my view 10 the
immediate cause OF the disease. and afterward
lay bare the foundations OF my belief. The
proximate cause, in my opinion, is mild
chronic acidosis. which extracts the lime salts
from the fbrous tissue. muscles. nerves, cartil-
ages and bones.
thus look upon this affection as a general
disease. and the apparent localIzation in the
joints IS due to their structure and liability to
Injury The extraction OF the lime salts from
the 1brous tissue causes II TO swell and its
vascularity increases. with the loss Of the lime
salts the muscles get into condition of irri
table weakness-they waste. readily contract.
cramp frequently occurs, all the deep reheXes
are exaggerated. and even state OF rhythmic
tremor may be set up
There is not much lime in the nervous tissue,
but its abstraction leads 10 a marked result:
neuralgia pains readily occur, and even neuriHs
Is easily established The patients frequently
complain that the pains are worse at night,
and this IS almost universally Rscribed TO the
heat Of the bedclothes but when the patient
IS IN bed in the daytime the pains subside
though the heat OF the bedclothes' remains
the same The condition really is that the
blood is less alkaline at night, II is Conse-
ouently capable Of holding more lime, which IS
taken NJ from the tissues The night pains
can usually be obyisted by a drachm of sodium
bicarbonate and fifteen grains OF lime carbon
ate in a glass OF milk at bedtime
As more and more lime gets absorbed. you
get swelling OF the periartiCular tissues and
eTusion into the joint. this Serious efusion IS