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which is strikingly hereditary, so that in their production 

 heredity is always not only a potent, but an inevitable 

 factor wherever they exist or may co-exist. No one who 

 has ever suffered from gout is incapable, c&teris paribus, of 

 transmitting a tendency to some of its protean forms to his 

 children, and although in each case it may manifest itself 

 differently, yet it should never be forgotten that heredity 

 and variability are the two sources of the tissue proclivities 

 which attest the inherited taint of gout in every case. 

 Heredity, in .fact, necessitates the transmission ; variability 

 is accountable for the degree and variety of the inheritance. 

 Rheumatic gout, or rheumatoid arthritis, may be said to 

 bear the same relation to gout as chronic articular rheumatism 

 does to acute rheumatism or rheumatic fever; although it 

 may occur in persons who have never suffered from either 

 gout or rheumatism, whilst generally presenting evidences of 

 both, especially in its external characteristics. The pathology 

 of rheumatoid arthritis is still a qucestio vexata. Dr. Fuller's 

 views are as follows : " The disease should not be regarded 

 as of a hybrid character, or, in other words, made up in 

 part of rheumatism, in part of gout. It is my firm convic- 

 tion that, just as true rheumatism and true gout do both 

 manifest themselves at different periods of life in the same 

 individual, so rheumatic gout may arise in a person who 

 either has been, or may hereafter become, subject to true 

 rheumatism, or true gout, and that it has no connection with 

 either of these diseases, beyond that which attaches to it in 

 virtue of its being a constitutional disorder, producing local 

 manifestations in the joint." As Sir Alfred Garrod, however, 

 naively remarks : " It is a much easier task to prove what 

 rheumatoid arthritis is not than to give the slightest clue to 

 what it is." Irrespective of its pathology, I am more 



