256 CHRONIC ARTICULAR RHEUMATISM 



contractures of the muscles, the trophic cutaneous disturbances, and the simi- 

 larity of the chronic rheumatic joint changes to unmistakable nervous arthrop- 

 athies occurring in tabes, syringomyelia, progressive muscular atrophy, hemi- 

 plegia, progressive paralysis and also in peripheral neuritis. In the latter 

 disease rarefaction of the bony substance with swelling of the distal ends of 

 the extremities and the formation of club finger tips is observed (pulmonary 

 osteoarthropathy of P. Marie, see the compilation of W. Berent). In diseases 

 of the central nervous system disfiguring deformities appear with atrophy and 

 proliferation of the bones and cartilage, and these show a great resemblance 

 to senile monoarthritis, differing, however, by their more rapid course, absence 

 of pain, fissures in the capsule, and extra-capsular, osseous and cartilaginous 

 proliferations. 



To explain the muscular atrophy the assumption of a primary nervous 

 affection is quite unnecessary, since Charrier has shown that this atrophy 

 accompanies all joint inflammations, especially when they run their course 

 with effusion (Kremer). Hoffa proved that they do not occur when the 

 centrifugal nerves are severed; they are, therefore, trophoneuroses which are 

 produced by reflex action initiated by the diseased joint surfaces. 



As anatomical investigation of the spinal cord has given positive results 

 only in rare, exceptional cases (E. Wichmann) the neurotic explanation seems 

 scarcely probable. Under certain circumstances, some forms of arthritis might 

 be looked upon as infectious trophoneuroses, following Teissier and Eoque. 



It is, however, quite unlikely that the various forms of chronic articular 

 rheumatism are due to any single cause. In the first place, we may exclude 

 monoarthritis deformans, which is so closely allied to other senile changes 

 (Weichselbaum) and which is so frequently produced by trauma. But it is 

 also unlikely that there is any one cause for all cases of chronic polyarthritis, 

 if we bear in mind the forms which are similar in all these symptoms, and 

 yet are produced by various well Tcnown and quite distinct infectious diseases. 

 Gerhardt in 1896 originated the term acute rheumatoid or pseudo-articular 

 rheumatism, and defined it as follows : " Pseudo-articular rheumatism is that 

 form of disease in which it may be proven, or where it is very likely, from 

 its external appearance, that it is produced by the special pathogenic organ- 

 isms of a definite infectious disease; the remaining cases are included under 

 true articular rheumatism." These pseudo-rheumatisms have in common that 

 they occur only in a minority of the individuals who are attacked by the 

 infection in question and that the same organism which produces the infectious 

 disease also produces joint pain, arthritic swelling or suppuration of the joint. 

 In this sense we may speak of chronic rheumatoid (" pseudo-rheumatism" of 

 Pribram) as an arthritis in which the exciting cause is one of the acute 

 exanthemata, influenza, or pneumococcus infection, particularly gonorrhea, 

 syphilis and tuberculosis. Gonorrhea is a clear example of the fact that the 

 same microorganism, according to its virulence and the individual constitu- 

 tion of the affected person, may cause any grade of the disease from a transi- 

 tory arthritic pain and serous effusion to an incurable, chronic deforming 

 arthritis and spondylitis. I should like to call particular attention to rheu- 

 matic tulerculoid or tuberculous rheumatoid, a condition which lately has been 



