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.

    22/612 (page 6)
    Could we but know wherein consists the difference between this man and one in unshaken health, we should know what gout is. GOUTINESS. We have still, then, to deal with that earlier period of ' general gout' which pathological anatomy fails to recog- nise. That this period is not one of health, neither the patient nor the physician needs telling; but how soon they may succeed in identifying the ill-defined cause depends upon their personal experience. A patient may not develop ' local gout' until he has passed through an ordeal of symptoms, which for a time may have afforded equal scope for the shrewdness of observers or for their scepticism. This important stage of ' general gout' is our oppor- tunity for that better form of cure, prevention. The stage of purely functional disturbance possesses no strict nosological position, but for chnical purposes the term ' goutiness' seems the most appropriate. Goutiness may last for long periods or to the end ; but its tendency is to develop into declared articular gout. The vagueness of the term is not a drawback, in view of the ill-developed character of the conditions to which it applies; its comprehensiveness is an advantage, for their variety often includes minor local changes, such as phalangeal nodules or tophi, etc., the presence of which removes all doubt as to the genuinely gouty nature of the rest. Being a purely clinical expression, it does not appreciably comphcate the question ; and whilst asserting the gouty complexion of the symptoms, it leaves un- touched the obscure problem of the antecedents of gout and of the constitutional basis of the affection. We may, then, bear in mind provisionally the following varieties: