PATHOLOGY - ARTHRITIS DEFORMANS.
The question of the pathology of arthritis deformans is one to which very different answers, all more or less tentative, have been and are still returned, and it is obvious that there is ample room for differences of opinion upon this point, seeing that the joints may suffer in a great variety of diseases of widely different types.
Arthritis is among the most conspicuous manifestations of certain infectious diseases, such as pyfemia and tuberculosis. In this class also the so-called gonorrhoeal rheumatism must be included, and there is much evidence short of actual proof that acute rheumatism itself is clue to a micro-organism.
Then, again, forms of arthritis are me With in the course of certain other acute fevers, in which, however, they play a very minor role.
Secondly, the arthritis of gout is constantly associated with the deposition of an abnormal chemical product in the articular struc tures, and there is much reason to think that we have here to deal with a form of arthritis dependent upon a derangement of the chemi cal processes of the body.
Thirdly, arthritis may result from an injury, as in the case of the common traumatic syuovitis of the knee.
Fourthly, there is a group of arthritides which are associated with the various diseases in which hemorrhage is a conspicuous symptom, such as hemophilia, scurvy, and the various forms of purpura.
Lastly, there are those interesting joint lesions just discussed which have their origin in connection with various disorders of the nervous system, and are almost certainly due to disturbances of the nutrition of the parts to which such disorders give rise.
It is pyina facie probable that in one or other of the above groups arthritis deformans should find a place, and the time has now come for the consideration of the argument for and against its inclusion in any one of them.
The chief views as to its nature which have up to now been ad vanced may be enumerated as follows : 1. That the disease is nothing more nor less than a variety of chronic rheumatism ; 2. That it is a disorder of mixed pathology, a hybrid so to speak, resulting from the admixture of rheumatism and gout; 3. That it is largely of traumatic origin, resulting from mere wear
and tear of the joints; 4. That in many instances the disease known as arthritis defor mans is nothing more than a senile change; 5. That the joint lesions are of dystrophic nature, and are depen dent upon disorders of the nervous mechanism which controls the nutrition of the joints.
It should be pointed out that of the five views above enumerated, the first and second look upon arthritis deformans as a systemic dis order of which the articular lesions are manifestations, while the last three do not involve the supposition of a general disease, but deal only with lesions of the joints, and of other parts the nutrition of which is liable to be simultaneously affected.
What may be styled, for the sake of brevity, the rheumatic theory has held a prominent position all through the history of our knowl edge of arthritis deformans. This was the theory of Charcot and of Trastour, and has been adopted almost universally by the members of the French school, at any rate up to quite recent times.
At the present clay it still has many supporters, and is backed by such an amount of powerful authority that its claims deserve most careful consideration, and cannot be lightly set aside.
It is a fact which cannot be denied that multiple arthritis defor mans in its most typical form may follow an equally typical attack of acute rheumatism, and, as we have already seen, Sydenbam clearly described this order of events ; but the value of any argument based upon this is seriously impaired by the equally indisputable fact that in the great majority of instances, a majority compared with which the number of the post-rheumatic cases sinks into insignificance, ar thritis deformans has its distinctive characters from the first, being developed de 17000 without any antecedent rheumatic attack. More over, as we have seen, acute rheumatism is not the only disease affect ing the joints of which arthritis deformans may occur as a sequel.