The evidence in favor of the doctrine that true articular rheumatism transmits an hereditary tendency to rheumatoid arthritis does not appear to be conclusive, although it is highly thought of by those who regard the latter disease as a variety of rheumatism. Some considerations of an opposing character deserve mention. Acute articular rheumatism has very rarely passed continuously into rheumatoid arthritis, and very rarely has been followed at short interval by that disease; and in such exceptional cases the antecedent affection may have been really the acute form of rheumatoid arthritis, which closely resembles acute articular rheumatism. Trastour,[235] Vidal,[236] Charcot,[237] and others admit that acute rheumatism can hardly be placed amongst the antecedents of the rheumatoid affection. Garrod[238] with some others states that now and then acute rheumatism acts as an exciting cause of it, which appears to have been Fuller's view;[239] he had repeatedly known it to commence apparently as a sequel of acute rheumatism. However, Ord met with a case in which the lesions of rheumatoid arthritis were present in a typical form in a patient who had mitral disease as a result of acute rheumatism, the arthritis having begun as a continuation of the acute attack.[240] [Footnote 235: _Thèse de Paris_, 1853, p. 41.] [Footnote 236: _Ibid._, 1855, p. 9.] [Footnote 237: _Leçons Cliniques_, p. 214.] [Footnote 238: Reynolds's _Syst. Med._, 1870, i. 920.] [Footnote 239: _Lib. cit._, 333.] [Footnote 240: _Brit. Med. Jour._, 1880, i., 158.] That so common an affection as articular rheumatism should occur in the family or personal history of a patient the subject of the rheumatoid arthritis is not improbable; nasal catarrh and many other very common diseases must be frequent antecedents of the rheumatoid affection, yet are not causes of it. Much the same remarks apply to the view that gout in the parents may transmit a tendency to rheumatoid arthritis in the offspring. The experience of English physicians in this matter is hardly reliable, owing to the great prevalence of gout in England. In Canada and many parts of the United States, however, while gout is a rare disease, rheumatoid arthritis is a common one, and the writer has not found an intimate relationship to obtain between the two affections. It is not intended to deny that when the children of rheumatic or gouty parents fail in health owing to their inherited constitutional disease, they become liable to rheumatoid arthritis, for feeble health predisposes to that affection.