CHRONIC ARTICULAR RHEUMATISM 



By W. his, Basel 



In attempting to describe a disease so familiar and commonplace as chronic 

 articular rheumatism (this appears to be the prevalent opinion in regard to 

 it), it is almost necessary to begin with a captatio benevolentice. A few years 

 ago, when I began to study this disease somewhat in detail, I learned that it 

 had long attracted the attention of many scientists. The last of the greater 

 compilations, that by Pribram, although by no means exhaustive, contains 

 notes of over 500 investigations which refer to chronic articular rheumatism, 

 and among the authors are found the most prominent names in medical sci- 

 ence, of whom I shall mention Charcot, Bouchard, Lancereaux, Pierre Marie 

 in France, the Garrods, father and son, in England, Richard Volkmann, 

 Senator, Baumler, and Albin Hoffmann in Germany. 



The disease is by no means a new one; it was familiar to the ancients 

 who confounded it with gout and designated it by the collective term arthritis. 

 It was not until the year 1800 that Landre-Beauvais expressly pointed out 

 that the disease was a distinct entity. Alfred Garrod in his celebrated book 

 on gout proved that the deposit of urate salts which is the materia peccans 

 in the joints affected by gout never occurs in chronic articular rheumatism. 

 Nevertheless, there are still some authors who, even in recent years, have 

 endeavored to merge the two diseases, believing them to be one. This attempt 

 is due to the fact that certain phenomena in the joints, and many of the 

 accompanying and subsequent symptoms in both diseases, may be the same; 

 we shall refer later to this point more in detail. 



The manifestations of chronic articular rheumatism are very various, and 

 if the descriptions of different authors are compared with one another, it is 

 often difficult to believe that they are portraying the same disease. What 

 one experienced observer describes as a frequent finding, another, no less 

 experienced, has scarcely ever seen. Similar to this is the variety of opinions 

 in regard to the etiology ; greater diversity of views can scarcely be conceived. 

 According to some authors, for instance, M. Schliller and Bannatyne, chronic 

 rheumatism is an infectious disease in which there can be invariably demon- 

 strated certain microorganisms; to others (Bouchard, Lancereaux) the disease 

 is the expression of a constitutional anomaly which is markedly hereditary, 

 running in families, and showing itself by numerous other symptoms. Other 

 writers believe that the affection is in the main a local process confined to the 

 joints and periarticular tissues. Finally, there are some who consider it a 

 disease of the central nervous system. 



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