Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    838/976 (page 818)
    When the deposition is confined to the cartilages, unless very extreme the injury to the mobility of the joint is comparatively slight, but when the ligaments are infiltrated, they are made rigid, and the play of the parts is consequently seriously interfered with. Much distortion is caused when the bursae become infiltrated, which, at times, takes place to an enormous extent; and, in explanation of this, it may be well to state, that the amount of secretion of urate of soda has no necessary relation to the acuteness of the inflammation. Without the aid of drawings, it is not an easy matter to give even an idea of the extent of crippling and deformity which occurs in some subjects who have suffered from severe chronic gout. The hands become greatly altered in appearance; sometimes, when the deposits are chiefly located in the ligaments and tendons, extreme stiffening takes place, without any important amount of bulging; many of the phalangeal joints become rigid and flexed, others equally rigid, but extended beyond the straight line or curved backwards; thus the metacarpo-phalangeal of a finger may be flexed, the first phalangeal joint curved backwards, and the second phalangeal articulation sharply flexed ; one or several fingers may be thus affected. At other times, not only is there anchylosis of several joints, but likewise great deposition of matter, which causes bulgiug at different points, from the formation of concretions more or less hardened. In extreme cases, an appearance is presented by the hand very closely resembling a bundle of Erencli carrots with their heads forwards, the nails appearing to take the place of the stalks ; sometimes the toes are affected, though usually in a less degree. The bursas over the elboAvs are often distended till they attain the size of small oranges ; the bursae over (the patellae may likewise become enlarged. Deposits of different sizes are found along the shafts of bones apparently origi- nating in the periosteum; also on the tendinous sheaths of some of the muscles ; in fact, every bursa may be affected, as likeAvise eArery tendon and membranous structure, and thus no limit can be set to the deformity which chronic gout can produce. When external deposits are visible in any patient, no possible doubt can exist as to the nature of the case, for as the deposition of urate of soda in the tissues occurs only in Gout, its presence constitutes a pathognomonic sign; but, as before observed, the occurrence of visible chalk-stones is not constant, for it was asserted by Sir G. Scudamore that not one gouty case in ten exhibited them. This statement however is not correct, for the small concretions we have described in the ear are extremely frequent, and may constitute for many years, or even during life, the only visible deposition of urate of soda throughout the body; and as they produce no amount of inconvenience, they may alto- gether escape notice, unless specially sought for. Some few years since, having been able in some difficult cases to make correct diagnosis fro in the presence of these aural deposits, the writer A\ras induced to in- vestigate the matter, and, in thirty-seven cases examined within a short period, they Avere found to be present in sixteen cases; in se\ren no other