Gout and goutiness : and their treatment / by William Ewart.

  • William Ewart
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Gout and goutiness : and their treatment / by William Ewart. Source: Wellcome Collection.

    21/612 (page 5)
    only reliable criterion for gout. Prior to the first articular outbreak, the significance of the clinical events can only be guessed, and their cause is often overlooked or mis- understood. THE MANIFESTATIONS OF GOUT. The fact is, we know gout only through its manifesta- tions. The local manifestations, even at their onset, are^ bound up with structural changes, which have supplied abundant material for pathological study. The seats of * local gout' are varied ; it occurs in the upper extremity or the lower, in the larger joints or in the smaller ones, though more often in the latter; it may affect the external ear with chalky deposit, or the palmar fascia with Dupuy- tren's contraction; but in the viscera, except the kidney, the local changes are difficult to trace, though we occa- sionally gain evidence as to their situation. With the general manifestations it is otherwise; for long periods the change is in the function rather than in the structures, and the latter afford no object lesson for the pathologist. Nevertheless, in its ultimate stages and in its gravest form, when it has long been complicated with the local accidents, ' general gout' obtains full recog- nition. In the gouty cachexia of this stage structural change is unmistakably present; but it is of a kind more obvious to the eye in its general aspect of decay than to the finer instruments of research in its details. We should not, however, assume that gout exclusively resides in its structural manifestations. A man may remain gouty even if some accident should deprive him of a limb, and, with it, of his ' local gout.' He will not long escape fresh inroads and settlements of the enemy, if he should continue to neglect to guard against its approach, nay—sometimes in spite of vigilance itself.