By the term "Primary Chronic Progressive Arthritis" is generally understood nowadays a joint affection beginning, as a rule, at forty to fifty years of age, without fever and chronic. Its development is very slow, and it may appear in many, often in two similar joints, either without or with a small amount of exudation, and with thickenings in the capsule and pericapsular tissue. On placing a hand over the joint (for example, over the knee) while the patient performs movements, one feels a slight grating or crepitation. The disease often begins in the fingers or wrists and in the joints of the foot, and may proceed to attack more central joints, or may only appear in these latter.

Among the cases of this progressive chronic arthritis, which is also aptly termed "arthrite seche," "dry arthritis," the disease affecting both knees, known as "synovitis crepitans," is the most common. I have certainly seen and treated more than a hundred cases of this curious complaint, which was formerly often known as chronic rheumatism, and in England and America as "rheumatic gout," in spite of the fact that it has nothing to do with rheumatism or gout. It generally occurs in fat women, beginning slowly and insidiously at about forty to fifty years of age. The patient complains of pain and stiffness in one knee, especially in the mornings. On examination one always finds that both knees are affected, although one is worse than the other.

Dry arthritis is one of the most important diseases of joints from the point of view of the masseur, because it is very common, because it yields excellent results to hard, but only to hard, frictions, and because it ought to be treated for some weeks every year. It can never be cured. If it is left to itself it often develops into a serious arthritis deformans.

It is well to make use of Bier's bandage, local hot baths and injections of fibrolysin, as well as massage and gymnastics.

Those forms of chronic "dry" progressive arthritis which attack the small joints of the hands and feet, which are not uncommonly seen on the fingers of both hands as "arthritis nodosa" or "poor man's gout" are thankless cases for mechano-therapy. They often develop into serious cases of arthritis deformans.

If this progressive arthritis does not attack too many joints, especially if it does not attack the joints of the spine, it does not seriously threaten the general health. If a patient with dry arthritis, by taking massage for a few weeks every year, prevents the complaint limiting her physical exercise too much, she may enjoy good health for years.

If physical exercise is too much limited or altogether prevented, the general health suffers seriously, and the patient's power of resistance is very much lessened.

As far as aetiology is concerned there is no foundation for any theory of infection nor for confusion with the condition following rheumatic fever. In this complaint we have no fever and no endocardiac changes. The complaint is as inexplicable as obesity, from which these patients often suffer before the trouble in the knee has restricted their physical exercise. Suppositions either as to disproportion of the body weight to the strength of the structure of the joints, or changes in the central nervous system, or toxic influences of bacteria in other parts of the body, or rheumatic influences have not hitherto been supported by observations.