BHEUMATOID ABTHRITIS. 215 



In support of this view of the pathology of this disease, I take 

 the liberty of quoting some remarks made by Dr. G. "W. Balfour 

 of Edinburgh in a clinical lecture published in the Edinhurgh 

 Medical Journal, February 1870, page 713. He says — "You 

 may remember, at the close of my last lecture, that I exhibited 

 to you the bones of a horse affected with rheumatoid arthritis. 

 The case to wh^.ch I then referred is still under treatment, 

 though improved ; and 1 purpose referring now more at large to 

 the subject. I brought these horse bones the other day for 

 several distinct reasons : — Id. To show you well-marked ex- 

 amples of eburnation on a larger scale than we ever have them 

 in human joints ; 2d. To show you that this eburnation, in the 

 horse at least, is not confined to the surface of the bone — is not 

 therefore produced, as has been supposed, by mere consolidation 

 and polishing produced ty friction, as you would polish a piece 

 of hard wood or dead bone ; for you remember, in the one bone, 

 the OS naviculare-^a sesamoid bone, not exposed to friction or 

 pressure at aU — this eburnation had extended throughout the 

 whole substance of the bone, showing that probably the process 

 is an integral part of the disease, and does not depend on friction 

 at all, — as, indeed, in living bones we could scarcely expect 

 would be the case ; and Zd. To show that horses, who live so 

 very differently from man, both as regards food and drink, and 

 who never have gout, are yet commonly affected by a disease 

 which produces precisely the same pathological results as rheu- 

 matoid arthritis in man, thus affording additional proof that 

 rheumatoid arthritis has nothing gouty in its nature ; and 

 showing that, to obtain anything like a proper and profitable 

 pathological history of this disease, we must include the lower 

 animals in our survey. As yet very little is known of rheuma- 

 toid arthritis, and yet it is of importance to know that little ; 

 becuQse it is of the utmost consequence to recognise both the 

 acute and chronic disease, the treatment being so dissimilar 

 from that of the diseases with which they are apt to be con- 

 founded — chiefly rheumatism and gout — but which may also in 

 the early stages include locomotor ataxy and Bright's disease, both 

 of which are frequently associated with pains which might be 

 mistaken for those of rheumatoid arthritis, an old disease, long 

 known by those skilled, but little recognised generally by the 



profession Eheumatoid arthritis appears to be a 



diseastj arising from exposure to cold and damp, but only in a 



