On some rare and new diseases : suggestions for the study of part of the natural history of disease : the Bradshawe lecture delivered at the Royal College of Surgeons of England in 1882 / by Sir James Paget.

Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: On some rare and new diseases : suggestions for the study of part of the natural history of disease : the Bradshawe lecture delivered at the Royal College of Surgeons of England in 1882 / by Sir James Paget. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    18/32 page 18
    which it is maintained, must add to the number, the diversity and the extent of variations from the type of health. But, through the benevolence towards the weak which is a constant part of educated humanity, there are few deviations from the type of health which are not main- tained and transmitted, whether alone or in combination. Now, I half wish that I could escape from the necessity of testing my doctrine by my facts; but, as I have often asked myself, so others may ask—How can the cases of rare diseases of which I have been speaking be explained as the results of morbid conditions changing and com- bining in transmission from parents to offspring? In the phlebitis we may often trace a variation from the customary type or standard of the very old and heritable disease, gout. In many cases its relations to typical gout are clear. The patients are members of gouty families, and in many of them other signs of gout are evident, either coincidently with the phlebitis or at other times; it lias, in short, ample evidences of being one of the many forms of what is called ‘incomplete gout.’ But, for a, reason why this variety of gout settles (if I may so speak) in veins, especially in those of the lower extremities, I can only guess at a convergence of inherited dispositions both to a modified form of gout and to some conditions of veins rendering them, among all the structures, the most sensitive to the gouty process. Certainly it is not accident which determines the disease to the veins, for this disease, as the saying is, ‘ runs in families.’ I know of its occurrence in two brothers and three of their cousins ; and I have heard Sir Charles Locock tell of four sisters who had phlegmasia dolens, and whose father had crural phlebitis. I am conscious that this is little more than guessing, and for the osteitis I must guess still further; or, rather, let me say that, to the furthest bounds of propriety, I must
    digitised image 1
    digitised image 2
    digitised image 3