A system of practical medicine. By American authors. Vol. 2

by Unknown

²³⁶ Ibid., 1855, p. 9.

²³⁷ Leçons Cliniques, p. 214.

²³⁸ Reynolds's Syst. Med., 1870, i. 920.

²³⁹ Lib. cit., 333.

²⁴⁰ Brit. Med. Jour., 1880, i., 158.

That so common an affection as articular rheumatism should occur in the family or personal history of a patient the subject of the rheumatoid arthritis is not improbable; nasal catarrh and many other very common diseases must be frequent antecedents of the rheumatoid affection, yet are not causes of it. Much the same remarks apply to the view that gout in the parents may transmit a tendency to rheumatoid arthritis in the offspring. The experience of English physicians in this matter is hardly reliable, owing to the great prevalence of gout in England. In Canada and many parts of the United States, however, while gout is a rare disease, rheumatoid arthritis is a common one, and the writer has not found an intimate relationship to obtain between the two affections. It is not intended to deny that when the children of rheumatic or gouty parents fail in health owing to their inherited constitutional disease, they become liable to rheumatoid arthritis, for feeble health predisposes to that affection.

Finally, many of the difficulties connected with this subject are reasonably met by Hutchinson's²⁴¹ doctrine that there exists a state of tissue-health which is transmissible by inheritance, which involves liability to inflammations of joints and fibrous structures, and upon this arthritic diathesis as a foundation may be built up, under the influence of special causes, a tendency to gout, rheumatism, or any one of their various modifications or combinations.

²⁴¹ Trans. International Med. Congress, ii. 95; Guéneau de Mussy's chap., "De la Diathèse Arthritique," Clin. Méd., 1874, t. i. 317-338.

Hutchinson has demonstrated that gout is often followed by rheumatoid arthritis, the lesions characteristic of both affections coexisting in the same joint. Charcot and Cornil had previously observed the same thing.²⁴² Acute and perhaps chronic rheumarthritis have sometimes preceded rheumatoid arthritis. If a predisposition, inherited or acquired, to rheumatoid arthritis exist, the occurrence of gouty or rheumatic irritation in the joints may suffice to induce the peculiar form of disturbance characteristic of the rheumatoid affection, just as injuries sometimes develop the partial form.

²⁴² Mémoires de la Société de Biologie, 1864.