There has been considerable debate regarding the possibility of being predisposed at the same time to gout and to rheumatism. It is a well-known fact that in the same families gout and rheumatism may follow or may alternate with each other in sucessive generations. Gouty parents may have rheumatic children, and vice versa. Conse quently, it does not seem in the least degree improbable that both tendencies may be transmitted, say from a gouty father and a rheu matic mother, so as to be united In one or more of their offspring. It may be that in this mixed predisposition can be found the expla nation of that combination of the clinical symptoms of both diseases that is sometimes witnessed. It is not improbable that many gouty subjects are patients who were originally predisposed to rheumatism, but have become gouty through improper habits of life.
The masked forms of gout often afford considerable difficulty in the matter of diagnosis. It is not in the clinical picture of the disease that obscurity lies, but in the definition of the remote cause of the symptoms. Thus it is not difficult to recognize the existence of a. headache, an attack of neuralgia, a paroxysm of asthma, or an erup tion of eczema; hut the determination of their ultimate cause is not always easy. For those who refuse to enter upon such investigations,
inquiries of this nature are without interest, and the possibility of diatheses, or predispositions to particular forms of disease, is out of the question. But for one who looks beyond the mere anatomical lesions and forms of disease into the realm of antecedent causes. nothing can exceed the importance of such researches, not only for the sake of completing the circle of knowledge, but in order to secure information that is competent to direct the course of therapeutical endeavor. To decide as to a given case of headache or neuralgia, whether it be due to malaria, or syphilis, or an hereditary tendency to gout, is a matter of prime importance for the welfare of the patient. In like manner, the early recognition of a similar hereditary predis position is invaluable for the proper safeguard of one who may, if neglected, become in later life the victim of confirmed articular dis ease. Without recognition of an hereditary diathesis, such previsions must be either impossible or destitute of a legitimate foundation.