Four years later, in 1905, Czerny described under the name of "exudative diathesis" a disease which was in danger of disappearing from medical literature. Tie considered those symptoms as most char acteristic which we have printed in italics in Comby's symptomatology so as to avoid repetition. But these do not, by any means, give an ex haustive picture and Czerny mentions many important details; though we must regard it as very strange that he should not have observed any symptoms referable to this diathesis in the digestive tract (with the exception of geographic tongue); whilst he includes the phlycterue which all other investigators (with the exception of A. Schutz and Moro) have eliminated and considered as part of scrofulosis. Czerny as well as Moro insist upon the importance of the circular caries of the incisors, and quite recently Czerny regards a premature flattening of the weight-curve during the first half year of life as a sign of exudative diathesis.
To-day we are still unable to decide, if we should regard the narrow ing of the syndrome by Czerny as against the French school of pediatrists as a progress, though we will not deny this being likely. One explanation for this difference of opinion may be found in the fact that Czerny in his first reports considered almost exclusively the symptomatology in very young infants.
Etiology, Pathogenesis and authors found the origin of these abnormalities mostly "in a distemper of the entire lymph system" which was supposed to be accompanied by a faulty, i.e., either a "sluggish" or an "acrid" condition of the lymph, leading to lymphatic stasis and thus to congestion in and hardening of the glands (Jiirg, 1826). It deserves special mention that even at that early date the following were mentioned a.s causes: I, heredity; 2, over-feeding and an improper choice of food in infancy, in some cases even mother's milk was considered an improper food; 3, respiratory damages and other hygienic deficiencies.
It was no more possible at that time than it is to-day to give a clear cut differentiation between the causes of the (latent) diathesis as such and the particular factors which evoke its external signs.
We can not give here the details of similar hypotheses nor of other older ones.
Bouchard (Maladies par ralentissetnent de la nutrition, Paris, 1882) places arthritism together with diabetes, gout, asthma, obesity, lithiasis, migraine, etc., into one group, namely the bradytrophies, i.e., those dis orders which are based upon an habitual slowing of metabolism. Space does not permit us to go into Bouchard's views, which have not been accepted in Germany, though Bergmann has quite recently proved the occurrence of an endogenous and truly constitutional type of obesity and has thus supported materially these theories. Comby's definition
of arthritism in conformity with Bouchard is that. of: "an habitual dis turbance of nutrition transmitted by heredity" and he characterizes it as "the diathesis of wealthy and civilized nations, the dyscrasia of an urban population and of the intellectual classes, the vast degeneration of races which suffer from exhaustion due to the overloading of stomach and brain." He claims that an insufficient digestion of assimilable foods and also a disturbance of the internal metabolism lead to intoxi cation and thus to the symptoms.
We arc inclined to think from what Bouchard has taught us, as well as from certain conditions of the urine and still more from our therapeutic successes, that the arthritis of children might be a true "uric6mie" (an uric acid diathesis) and thus of the nature of an infantile equivalent of true gout; though we have not yet sufficient proof for this view, neither is the opposite proved, in spite of the careful investigations of Goppert. As far as we are aware none of the fairly conclusive bio chemical methods of examination of the gouty disturbances of metab olism have been carried out in "arthritic" children (such as the quanti tative changes in the elimination of the purin-bodies under a purin-frec diet, the reaction to consequent addition of purins to the diet, the quantitative analysis of the blood for uric acid, etc.).
Comby places most importance on the factor of homologous and heterologous heredity for the occurrence of the arthritic diathesis, and he does this based upon the observation of a large number of cases. He finds in the parents and other nearest blood relatives of these sick chil dren a remarkable frequency and gravity of the bradytrophie diseases of Bouchard (see above), as well as all kinds of neuropathies and psychop athies. Long-continued observation of single patients as well as of whole families help him, not only in recognizing the relation of the different symptoms depending upon this constitutional abnormality, but also to define their limits.
Heubner finds the cause of lymphatism in a congenital tendency towards an excessive hyperplastic reaction of the lymphatic tissues. He claims that a certain external injury, a specific agent, should not be sought for on account. of the frequency of the condition, which, according to this author, is found in all degrees down to the more pronounced development of the infantile lymphatic apparatus which may be con sidered as physiological and might be regarded as "a function of develop ment, of growth itself." Infectious and alimentary injuries may, however, act as a stimulus.