n trouble the patient,
and the skin is sometimes smooth and glossy or freckled.

The general health suffers, and weakness, anaemia, and dyspepsia are
common. Even though most of the joints become useless, there is often
sufficient suppleness in the fingers to allow of their use, as in
writing or knitting. In old men the disease is seen attacking one
joint alone, as the hip, shoulder, knee, and spine. Children are
occasionally sufferers, and in young women it may follow frequent
confinements or nursing, and often begins in them like a mild attack
of rheumatic fever. The heart is not damaged by rheumatic gout.

It is frequently impossible to distinguish rheumatic gout from chronic
rheumatism in the beginning. In the latter, creaking and grating
sounds on movement of the joints are less marked, the small joints, as
of the hand, are not so generally attacked, nor are there as great
deformity and loss of motion as is seen in late cases of rheumatic
gout.

=Outlook.=--It often happens that after attacking several joints, the
disease is completely arrested and the patient becomes free from pain,
and only a certain amount of interference with the use of the joint
and stiffness remain. Life is not necessarily shortened by the
disease. The deformity and crippling are permanent.

=Treatment.=--Rheumatic gout is a chronic disease in most instances,
and requires the careful study and continuous care of the medical man.
He may frequently be able to arrest it in the earlier stages, and
prevent a life of pain and helplessness. In a general way nourishing
food, as milk, eggs, cream, and butter, with abundance of fresh
vegetables, should be taken to the extent of the digestive powers.
Everything that tends to reduce the patient's strength must be
avoided. Cod-liver oil and tonics should be used over long periods.
Various forms of baths are valuable, as the hot-air bath, and hot
natural or artificial baths. A dry, warm climate is most appropriate,
and flannel clothing should be worn the year round. Moderate exercise
and outdoor life, in warm weather, are advisable, and massage, except
during the acute attacks of pain and inflammation, is beneficial.
Surgical measures will sometimes aid patients in regaining the
usefulness of crippled limbs.

=SCURVY.=--Scurvy used to be much more common than it is now. In the
Civil War there were nearly 50,000 cases in the Union Army. Sailors
and soldiers have been the common victims, but now the