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.

    25/612 (page 9)
    It might, in the first place, be questioned whether a diathesis which is acquired and that which is inherited are Hkely to be identical. But there are worse objections than this. It is a peculiarity of gout that it attacks indi- viduals of the most different types, habits, and consti- tutions, some of whom are already the bearers of other diatheses. The supposed ' gouty diathesis ' cannot, with- out strain, be made to fit such opposites as the over-fed, full-blooded, and plethoric, and the thin, half-starved sub- ject, the scrofulous, and the nerve-ridden patient. What can such extremes possess in common by way of disposi- tion ? The wonder is, rather, that goutiness should develop in all classes of subjects, irrespective of undoubted constitutional differences. Above all, there is no finality in the indulgence in ' diatheses '; it grows as a habit. Given an opening for some fresh diathesis, say in connection with the excessive excretion of uric acid, and a ' uric acid diathesis ' is forth- with set up. Indeed, this diathesis now claims the domain of gout with a title almost equal to that of the ' gouty diathesis ' itself. Yet the two diatheses, though they largely overlap, cannot be fused into one. They are both distinct and well-constituted ' diatheses.' The ' Uric A cid Diathesis ' embraces a great deal more than gout, vi^., all other conditions in which uric acid is in excess, whether they are as in gravel, indirectly related to gout, or as in leucocythsemia, absolutely foreign to it. There is, at any rate, something tangible in the uric acid diathesis: it implies a recognisable excess of a chemical substance ; but the 'gouty diathesis,' if it means anything apart from inherited delicacy, or from the earliest mani- festations of gout itself, is of exceedingly frail construc- tion, and falls to pieces if we endeavour to isolate it from its bearer. Doubtless much of the so-called ' gouty