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efficacy still exists, and this, notwithstanding the fact that we 

 may not be able to recognise it. I therefore contend that 

 chronic articular rheumatism being most frequently a sequela 

 of acute rheumatism, and a predisposition to the latter 

 being transmissible that although the latter is constitutional 

 and the former local, they stand towards each other as cause 

 and effect, and consequently a predisposition to the one 

 must include to some extent a predisposition to the other. 

 In the same category may be included myalgia, lumbago, 

 etc., which, whether dependent on inflammatory changes in 

 the muscular or the interstitial connective tissue, or neuro- 

 pathic conditions, are decidedly hereditary, as is proved 

 by every-day experience. I have myself known families, 

 members of which have suffered from attacks of lumbago 

 in one generation after another, and we have all seen the 

 same thing occur as to rheumatic cephalalgia, intercostal 

 rheumatism et hoc genus omnt. 



In approaching the consideration of the heredity of gout, 

 I am fortunately assailed by neither doubt nor difficulty, as 

 in the vast majority of all cases of gout, it occurs in con- 

 sequence of an inherited predisposition, and this is admitted 

 by all authorities. Out of 523 gouty persons, Scudamore 

 found that 309 had come from a gouty stock ; Gairdner, 140 

 out of 156 ; Garrod 75 per cent. ; and Braun, out of his 

 sixty-five patients, did not find one whose parents or grand- 

 parents had not suffered from the disease. Dr. Garrod, in 

 his classical work on " Gout and Rheumatic Gout," instances 

 the following cases : " A few years since, I was consulted 

 by a gentleman labouring under a severe form of gout, with 

 chalk-stones, and, although not more than fifty years old, he 

 had suffered from the disease for a long period. On inquiry, 

 I ascertained that for upwards of four centuries the eldest son 



