RHEUMATISM. 233 



We would first notice that it has been known for 

 centuries that the rheumatic as well as the gouty 

 were themselves specially liable to mental disorder, 

 the older writers correctly pointing out that the 

 mental aberration most frequently took the form 

 of melancholia, with more or less stupor in the 

 rheumatic, and acute mania in the gouty, and that 

 in both cases it at times terminated in hopeless 

 dementia. This being so, we are not surprised to 

 find " Rheumatic Insanity " and " Rheumatic and 

 Gouty Insanity" appearing in various classifications 

 as recognised varieties of mental disease. Not only 

 are the rheumatic and gouty specially prone to inflam- 

 mations of the membranes of the brain, often causing 

 mental disorder which may become permanent, and 

 later in life to paralysis and dementia following apo- 

 plexies, and the deep and hopeless melancholia found 

 associated with diseased blood-vessels in the brain ; 

 but they are also liable above others to the ordinary 

 forms of mental disease. Dr. Clouston of Edinburgh 

 has published * some interesting cases of this rheu- 

 matic insanity, and has strongly insisted upon the 

 rheumatic origin of the mental disorder. 



All this, however, only relates to those who have 

 or have had rheumatism, and it still remains for me 

 to show that not these only, but their relatives also, 

 are specially liable to nervous disease having mental 

 symptoms. I would trace the relationship between 

 the rheumatic and the neurotic diatheses thus : 



* Journal of Mental Science, July 1870. 

 16 



