A manual of medical diagnosis / by A.W. Barclay.

  • Andrew Whyte Barclay
Date:
1857
Catalogue details

Licence: Public Domain Mark

Credit: A manual of medical diagnosis / by A.W. Barclay. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

    110/642 (page 86)
    of the first appearance of the disease. Gout seldom shows itself before the middle peiiod of life, while a first attack of acute rheu- matism is rarely met with after that age. The different duration of the attack in each case should also be borne in mind. Along mth these we must take into consideration the habits and aspect of the patient; for, while it is true that no degree of abstemiousness will serve to ward off the occurrence of gout when the predisposition is strong, it is unquestionably among the over-fed and the plethoric that it is most constantly found. No j)ositive rules of diagnosis can be laid down for determining the nature of what has been called erratic or unfixed gout; but we shall very generally be right in concluding that anomalous cases of disorder in gouty habits are mm-e or less due to, or modified by, the excess of uric acid. Gout is especially associated with disease of the kidney; and so frequently has this been observed, that some pathologists have spoken of the gouty kidney, a phraseologj' which is higlily objec- tionable. We may be also prepared to find other ill effects of intemperance in those who have brought on themselves this pain- ful infliction, but none of them have any definite relation to it. § 6. Rheumatic Gout.—We cannot refuse a separate place in our classification to a disease which, though its place in pathology be as 5'et undetermined, is very well marked in particular cases. The peculiar twisting and distortion of the joints in persons who have suffered for any length of time from its effects, is such as cannot pass unobserved by any one who is familiar with tlie aspect of disease. In its early history it partakes most of the character of sub-acute rheumatism. It differs from an acute attack chiefly in the absence of fever, and in the cir- cumstance that comparatively few of the joints are under its influence at the period of its commencement; there is a good deal of swelling, and perhaps of redness, of one or two joints, but these are not marked by the extreme tenderness and pain so distinctive of rheu- matic fever or of gout; while the local inflammation is more decided than in the sub-acute form of the dis- ease, if we exce])t a few cases which we have charac- terized as abortive attacks of acute rheumatism. If due consideration be given to these circumstances, the