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.

    874/976 (page 854)
    circumstances: the appearance of general good health; the distinct interval ot six months between the first and second seizures ; and the probability of the patient taking more malt liquors than she herself allowed. Io remove any doubt upon the subject, a very small venesection was performed, and upon analysis the serum was found to yield a large quantity of uric acid by the thread experiment. This was almost decisive of its being Gout; but on very close inquiry, finding that the elbows had been affected several times, the state of the burs® over the olecranon process was examined, and in the right bursa some thickening was detected, as likewise the presence of two or three little flattened masses, doubtless of urate of soda. The presence of these little masses in the bursa, conjoined with the fact of the blood being rich in uric acid, fully established the nature of the case; and this discovery was of no small importance, not only in the treatment of the attack, but as to the means to be taken in future to keep the disease from making further inroads in the system. Prognosis of Gout.—An attack of acute articular gout is probably never fatal, and individuals are often seen who have suffered from severe paroxysms for many years, and yet appear to have experienced little or no injury beyond their sufferings at the time. If the intervals between the seizures continue to be of fair duration, as one year or half a year, when the patient is beyond middle age, the prognosis is favourable, and there is no reason why any appreciable shortening of his life shonld ensue, provided he is willing to live according to rule, and is not exposed to accidents or other powerful causes of the disease ; in confirmation of this statement is the fact that robust-looking per- sons of very advanced age are not infrequently seen, who have been the subject of periodic visitations of Gont for a great number of years. When, however, in comparatively early life, the attacks are frequent and prolonged, the prognosis becomes much less favourable, and especially if the urine exhibits any trace of albumen, either during the paroxysms or in the intervals of freedom from them. The appearance of the patient’s urine helps us in making a prog- nosis. If it was formerly turbid from urates, or if it gave rise to a deposit of crystallized uric acid, and has become of late clear and of a paler colour, the change probably indicates that the kidneys have to a considerable extent lost their power of eliminating uric acid,, and that which seems to the patient a favourable change is in reality a sign of a serious structural alteration in an important secreting organ. It is a grave sign in Gout to find the urine pale, the specific gravity exceedingly low, and the fluid devoid of uric acid; and if, in addition to this condition, albumen is likewise present, the indication becomes still more unfavourable. _ I Chronic gout has a decided tendency to shorten life, and this fact is recognised by insurance companies, who, however, do not appear