The arthritis referred to in the 18th century was probably osteoarthritis and although there are one or two clinical descriptions in the case book suggestive of rheumatoid arthritis, it is thought that this disease did not appear in significant numbers until the end of the 18th century, reaching a peak at the end of the 19th century. The woman in the picture appears to have swollen metacarpo-phalangeal joints which is more in keeping with an inflammatory polyarthritis like rheumatoid. Gout was also common in men during the 17th and particularly the eighteenth-century although it tended to affect the better off. Some cases of gout at this time might have been caused by lead poisoning, a type known as saturnine
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