MULTIPLE ARTHRITIS DEFORMANS ETIOLOGY.
Even under the most favorable circumstances statistics of hered ity have only a doubtful value unless they are the outcome of per sonal observations by medical men of the diseases met with in several generations of a family. When, as is so often the ease, they are merely based upon the information supplied by individuals who are not in a position to give any accurate account of the nature of the maladies from which their parents or grandparents suffered, and whose acquaintance with their own medical histories is so imperfect as that possessed by the majority of the class from which hospital patients are drawn, their scientific value is reduced almost to the vanishing point.
This is true even of those diseases which have well-defined posi tions in the popular nosology, and, a fortiori, when we have to do with a disease such as that under discussion, which has no place at all in the popular mind as distinguished from rheumatism and gout, the difficulty of obtaining any trustworthy information will be greatly increased, or indeed practically insuperable.
The use of the term rheumatic gout affords an excellent example of the difficulties which surround investigations of this kind. In England arthritis deformans is the disease to which this name is commonly applied, and its employment in this sense has met with the approval of such high authorities as Dr. Fuller and Mr. Jonathan Hutchinson. When, on the other hand, we turn to the lower orders we find that among hospital patients rheumatic gout is the name by which true articular gout is almost invariably known, while arthritis deformans is included among the conditions which are described as " rheumatics." Obviously we have here a fruitful source of confusion and mystification.
Such statistics as I shall quote are based upon a series of five hundred cases which I extracted some years ago from my father's case books, and which were analyzed in a paper published in the Transactions of the Royal Medical and Ohirurgical Society in 1887." These patients were drawn from the more educated classes of the community, and the statistics are therefore somewhat more trust worthy than if they had been based upon a similar series of hospital cases. The following table embodies the results arrived at: In 284 cases there was no family history of articular disease.
It will be noticed that gout holds a prominent place in the list, being in the families of nearly one-third of all the cases.
Rheumatism occurs sixty-four times in all, but it is probable that some cases of arthritis deformans were so described. Of the re maining conditions such as hand-joint affection, deformed joints, and so on, which were probably of the nature of arthritis deformaus, there are eighty-four examples.
The proportion of gouty family histories is certainly high and seems to lend support to the view expressed by some eminent authori ties that the daughters of gouty fathers show a special liability to arthritis deformans. On the other hand it must be remembered that gout is extremely common in England among the classes to which these patients belonged.
The number of cases in which there was stated to be a family history of rheumatism was smaller, and there is little doubt that other conditions than true acute and subacute rheumatism were in cluded under this head. In spite of this the proportion of such histories is smaller than was the case among a series of five hundred hospital out-patients who had not themselves suffered from rheuma tism, and who were only questioned as regards the occurrence of actual rheumatic fever among their nearest relations. This result is interesting from its bearing upon the pathology of arthritis deformaus, in view of the opinion that it is merely a variety of chronic rheuma tism.