6o SMITHSONIAN MISCELLANEOUS COLLECTIONS VOL. 93 



gouty temperament." Pritchard (1891), speaking of ear exostoses 

 of certain kinds, says " as far as my own observations go, I am inclined 

 to the belief that they are usually of gouty or rheumatic origin." 

 Alderton (1898) saw in his case " a local gouty manifestation of the 

 constitutional diathesis." For Politzer (1902) gout was one of the 

 causes of the tumors; for Tod (1909) one of the chief causes; and 

 Noquet ( 1899) saw a case of bilateral ear exostoses in a gouty subject. 

 Sabroux (1901, p. 27) sums up the situation as follows: "Aside 

 from the syphilitic diathesis, we must mention in the etiology of these 

 conditions, arthritism and herpetism, diatheses which are nearly 

 equivalent and closely related if we consider their effects, and finally 

 the gouty diathesis." 



For Ballenger (1914, p. 662), gout is doubtful as a direct cause; 

 " it is more probable that the gouty diathesis causes an inflammatory 

 process of the skin and the periosteum, which finally undergoes a 

 retrograde change and becomes the seat of lime deposits." 



Rcvuirks. — Arthritic, gouty or rheumatic diathesis is a subject 

 still far from being well understood. It is not even definitely known 

 whether all the conditions comprised under these terms are merely so 

 many dift'ering manifestations of one basic diathesis, as it seems to 

 the writer, or whether they belong to two or more related yet dis- 

 tinct constitutional derangements. They do not, except perhaps on 

 very rare occasions, affect the external auditory canal. They cause 

 irregular osseous deposits in or about the joints, but never peduncu- 

 lated or circumscribed bony tumors. And they affect mainly those 

 above middle age, whereas exostoses are predominantly an affliction of 

 the earlier part of adult life. A very large proportion of the rheumatic, 

 arthritic, or gouty, moreover never develop ear exostoses. Where 

 then is the connection between the two conditions ? 



That ear exostoses may exist or develop in " gouty " subjects need 

 not be questioned ; that a gouty condition of the system may possibly 

 in some cases act favorably on their development could readily be 

 admitted, though proof should be furnished ; that an arthritic di- 

 athesis could be the sole cause of an ear exostosis is unexplainable and 

 is opposed by the mass of evidence presented by the extensive skeletal 

 materials at our disposal. 



The Eskimo oft'er perhaps the best refutation of a causal connec- 

 tion between arthritis and ear exostoses. Arthritis is frequent and 

 at times severe in these people, leading to marked joint deposits and 

 marginal exostoses — ear hyperostoses and exostoses are practically 

 absent. On the other hand, in our Kentucky, South Dakota, and Vir- 

 o-inia groups, where ear exostoses are most common, arthritic condi- 

 tions are no more frequent than usual in American material. 



