Licence: Public Domain Mark
Credit: A text-book of medicine : for students and practitioners. Source: Wellcome Collection.
1015/1108 page 987
Licence: Public Domain Mark
Credit: A text-book of medicine : for students and practitioners. Source: Wellcome Collection.
![If there has been one attack of gout, there are almost sure to be others. They come sooner or later, at regular or irregular intervals, and separated by weeks, months, or even yeai-s. The attacks recur at long inteiwals in mild cas^, more frequently and at gradually diminishing intervals in the severe. Spring and autumn are regarded as the time when attacks of gout are most apt to occur. In these subsequent attacks the great toe still remains the part most constantly and severely affected ; but other joints may also suffer-for example, the wrist, the knee, or the shoulder. Sometimes traumatism or some previous affection of the joints—such as rheumatism—apparently determines the localization of the gouty disturbance. In each attack, the trouble is usually confined to a single joint. It is only in exceptional or advanced cases that several joints are simultaneously invaded. The longer the disease has lasted, the less typical are the separate attacks. There may now be less suffering at the time of an attack 5 but the articular changes are more persistent. There are symptoms referable to other parts of the body ; and the gout gi-adually passes into its second chronic or “atonic” stage. Occasionally the disease is irregular and atypical from its incipiency ; and the lii-st manifestations may not be arthritic, hut referable to the kidneys {vide infra) or other organs. 2. Atypical Gold. Gouty Disturbance of other Parts than the Joints.—Gant may affect the mucous membranes. A gouty dyspepsia is vei-y frequent. Its symptoms are more or less severe. The gouty are also subject to intestinal catarrh of varying severity, and to bronchitis and conjunctivitis, as well as to catanh of the urinary organs. Ebstein regards “ gouty gonorrhoea ” as essen- tially a catarrh of the excretory ducts of the prostate gland. It is not an easy matter to explain why these various forms of catarrh should occur in gout. They may be, some of them, complications. In other cases they are doubtless the result of passive congestion, due to cardiac failure {vide infra) ; but in still other instances it must be confessed that they ai-e appai’ently due to the toxic influence of the accumulated uric acid. [My experience, though far more limited than that of Draper, nevertheless leads me to believe, as he does, that the irregular forms of gout are by no means uncommon in Avomen as an inheritance from a previous generation. The mani- festations in some of these cases are so ill-defined that a diagnosis may he difficult without a knowledge of the family history ; in other cases, more or less deformity of the smaller joints, or slight recurrent swellings of those parts, throw much light on the condition underlying the symptoms.] Inflammation of serous membranes—for example, of the plem’a—also occurs ; and there may be pneumonia. The skin not infrequently suffers from acute or chronic eczema, which sometimes appears to be referable directly to the gout. Keratitis, iritis, and other inflammatory distm'bances of the eye are also said to be caused directly by gout. Cirrhosis of the liver has been repeatedly found, and is perhaps referable to the action of the uric acid upon the hepatic parenchyma. By far the most important of all these gouty manifestations are referable to the kidneys and to the circulatory system. The disorder of the latter is some- times sym])tomatic of the renal trouble, but in other instances it occurs inde- pendently of it. There may be severe gouty arthritis for yeare without any lesion of the kidiieys ; but this is exceptional. In severe cases of gout it is the rule that, sooner or later, symptoms of renal disorder present themselves. Tlie so-called “ gouty kidney ” is a form of chronic interetitial nejdiritis. However imix>rtjint tliis complication, its symptoms do not need to bo discussed hero, as they are pre- cisely similar to those seen in ordinary cases of contracted kidney {vide page 85(5, et seq). The distinctive symptom of this distm-bauce is albuminuria ; and the](https://iiif.wellcomecollection.org/image/b28135970_1015.jp2/full/800%2C/0/default.jpg)
