Excerpt from American Medicine, Vol. 3: A Weekly Journal Founded, Owned, and Controlled by the Medical Profession of America; January-June, 1902

This can be explained by an accumulation of effects from oftr repeated insults until tolerance has been overstepped; or by a progressive degeneration. This we meet in epilepsy, when only years after the injury the first symptom, appears. The English, who have, according to tradition, a particular claim on gout, owe it to the moist climate and the exposure in the much indulged hunting and other outdoor sports, which afford the best chance of getting soaked and chilled. The enjoyment of the good things of this world with which they are charged, they have in common, with many other nations that are not inclined to gout. The glutton who devours delicacies and drinks champagne all day, is in fact the careless fellow who does not mind rain and wet feet and similar little inconveniences, and therefore will get the gout whether he drinks champagne or ditch water. In the time of our wild frontier life, gout and rheumatism were most prevalent, and the doctor who would have traced them to gluttony would have been sent to a lunatic asylum. At the present time many of the younger physicians will not have an opportunity to see a case of true gout. The reason being the better housing, better raiment, and less exposure of this generation. As the differentiation between gouty and rheumatic arthritis is of great practical importance, I will discuss it briefly. There is no strict definition for either term, and according to my theory I will hardly be able to find one. Both are caused by the same extraneous causes, and I think with Ebstein that the involved parts must be structurally disordered to some degree of decl'osis, before the deposits can take place. In my opinion the nature of those deposits depends more upon the degree and nature of the destructive processes and upon the difference of the affected tissues, than upon the presence of a superabundance of uric acid in the body fluids, since we may have free precipitation with even a normal quan tity of uric acid in the blood, and no precipitation coupled with the greatest abundance of it. It seems to me reasonable to expect a different aspect of the disease when the cartilages, the bones, or the soft part of the joints are affected. The identity of the pathologic processes is acknowledged in practical medicine, and there is the same treatment for both, and the case may be pronounced either gout or rheumatism.

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