Gout, With a Section on Ocular Disease in the Gouty

CHAPTER X. The Renal Theory of Gout

THE RENAL THEORY OF GOUT

Anomalies in Uric Acid Excretion in Gout. Uricæmia in Nephritis. The Relationship, if any, between the Amounts of Uric Acid and of Urea, and Total Non-protein Nitrogen in Human Blood. Uricæmia not necessarily due to Renal Defect. Uricæmia not Peculiar to Nephritis. Uricæmia does not necessarily Portend Gout. To what may be ascribed the Deficient Eliminating Capacity of the Kidney for Uric Acid. Uratic Deposits in Nephritis. Differentiation of Uratic Deposits in Gout and Nephritis. Clinical Associations of Gout and Granular Kidney pp. 117-132

CHAPTER XI. Uricæmia in Gout

URICÆMIA IN GOUT

Folin and Denis’s Method. Uric Acid a Normal Constituent of Blood. Effect of Exogenous Purins. Uric Acid Content of Blood in Gout. Hyperuricæmia in Non-gouty Arthritis. Variations in Uric Acid Content of Blood independently of Diet. What Relationship, if any, Exists between the Uric Acid Content of the Blood and Attacks of Gout. Discussion of the Foregoing Data. The Significance of Uricæmia. Sources of Fallacy in Uric Acid Estimation. Disabilities of Modern Tests. Need for further Investigations pp. 133-148

CHAPTER XII. Uratosis in Relation to Gout

URATOSIS IN RELATION TO GOUT

Constitution of Tophi. Mode of Formation. Localisation of Uratic Deposits. The Causation of Tophi. Solubilities of Uric Acid. Tophi in Relation to Uricæmia. Tissue Affinities for Uric Acid. Retention Capacity of Tissues for Uric Acid. Clinical Evolution of Tophi. The Cause of the Inflammatory Phenomena. Non-toxicity of Uric Acid. Are the Precursors of Uric Acid Toxic? pp. 149-170

CHAPTER XIII. The Rise of the Infective Theory

THE RISE OF THE INFECTIVE THEORY

Boerhaave’s Forecast of the Infective Theory. Ringrose Gore on Infective Origin. Leucocytosis in Acute Gouty Polyarthritis. Chalmers Watson’s Researches on Gout in a Fowl. Trautner’s Suggestion of a Specific Infection pp. 171-176

CHAPTER XIV. Gout As an Infection

GOUT AS AN INFECTION

Local Foci of Infection: Dental, Nasal, Pharyngeal, etc. Gastro-intestinal Disorders. Variation in Free HCL. Intestinal Disorders. Infection or Sub—infection pp. 177-187

CHAPTER XV. Gout As an Infection (_continued_)

GOUT AS AN INFECTION (continued)

Analysis of the Acute Paroxysm. The Evolution and Life History of Gout. Analogies between Gout and the Specific Infective Arthritides. Correlation of the Metabolic Phenomena of Gout with the Postulated Infective Element pp. 188-199

CHAPTER XVI. Clinical Account

CLINICAL ACCOUNT

Acute Localised Gout. Prodromal Symptoms. Dyspepsia. Premonitory Symptoms of Tophus Formation. Premonitory Articular Pains. The Acute Paroxysm. Detailed Consideration of Phenomena. Mode of Onset. Localisation. Nature of Pain. General Phenomena. Pyrexia. Changes in the Blood. Uric Acid Excretion. Local Phenomena. Tophus Formation pp. 200-213

CHAPTER XVII. Clinical Account (_continued_)

CLINICAL ACCOUNT (continued)

Acute Gouty Polyarthritis. Mode of Invasion. Distribution of Lesions. Local Characters. Constitutional Symptoms. Changes in the Blood. Leucocytosis. Collateral Phenomena of Gout. Lumbago, Sciatica, etc. Incidence of Gouty Stigmata in Various Types of Fibrositis pp. 214-224

CHAPTER XVIII. Clinical Account (_continued_)

CLINICAL ACCOUNT (continued)

Chronic Articular Gout. The Joint Deformities of Chronic Gout. Tophi: Their Evolution and Distribution. Other Sites of Tophi. Affinities between Gout and other Diseases. Gout in Relation to Glycosuria. Gout in Relation to Phlebitis. Cutaneous Disorders. Gout and Nephritis. Prognosis in Gout pp. 225-246

CHAPTER XIX. Etiological and Clinical Diagnosis.

ETIOLOGICAL AND CLINICAL DIAGNOSIS.

Articular Gout. Etiological Diagnosis. Clinical Diagnosis. Introductory Remarks. The Diagnostic Status of Tophi. Tophi in Relation to Arthritis. Frequency of Tophi in True Gouty Arthritis Underestimated. Difficulty of Detecting Tophi pp. 247-257

CHAPTER XX. Clinical Diagnosis (_continued_)

CLINICAL DIAGNOSIS (continued)

Acute Articular Gout. Localised Variety. Differential Diagnosis. Infections. Acute Gonococcal Arthritis. Traumatic Lesions. Acute Osteoarthritis. Static Foot Deformities. Hallux Valgus with Inflamed Bunion. Hallux Rigidus. Metatarsalgia. Gout in the Instep. Gonococcal Arthritis. Tuberculosis and Syphilitic Disease of the Tarsal Joints or the Related Joints. Pes Planus. Gout in the Heel. Referred Pain. Local Sources of Fallacy. Post-calcaneal Bursitis. Synovitis of the Tendo Achillis. Gout in the Sole. Plantar Neuralgia. Erythromelalgia. Anomalous Sites for Initial Outbreaks pp. 258-267

CHAPTER XXI. Clinical Diagnosis (_continued_)

CLINICAL DIAGNOSIS (continued)

Acute Gouty Polyarthritis. Differential Diagnosis. Acute Articular Rheumatism. Acute Gonococcal Arthritis. Etiology. Onset. General Symptoms. Distribution of Lesions. Local Characters. Associated Phenomena. Secondary Syphilitic Arthritis. Acute Rheumatoid or Atrophic Arthritis. Age and Sex. Onset. General Symptoms. Distribution of Lesions. Local Characters. Associated Phenomena. Infective Arthritis of Undifferentiated Type pp. 268-274

CHAPTER XXII. Clinical Diagnosis (_continued_)

CLINICAL DIAGNOSIS (continued)

Chronic Articular Gout. Chronic Monarticular Gout. Monarticular Gout in Large Articulation a Rarity. Chronic Gout of Oligo-articular Distribution. Its Confusion with Chronic Villous Synovitis. Villous Synovitis Static and Non-gouty in Origin. Clinical Symptoms of Villous Synovitis. Bilateral Hydrarthrosis. Peri-synovial and Peri-bursal Gummata. Chronic Gout of Polyarticular Distribution. Differential Diagnosis. Osteoarthritis. Local Characters of Joint Swellings. Rheumatoid Arthritis. Local Characters of Joint Swellings. Nerve Arthropathies. Hæmophilic Arthritis pp. 275-285

CHAPTER XXIII. Clinical Diagnosis (_continued_)

CLINICAL DIAGNOSIS (continued)

Skiagraphy. Significance of Local Areas of Rarefaction. The Radiographic Types of Gouty Arthritis. Differential Diagnosis. Infective Arthritis. Hypertrophic or Osteoarthritis. Rheumatoid or Atrophic Arthritis pp. 286-292

CHAPTER XXIV. Irregular Gout

IRREGULAR GOUT

Historical Account. Murchison’s Views. Retrocedent Gout. Gout in the Stomach. Cardiac and Cerebral Forms. Other Irregular Manifestations. Conclusions. Infantile Gout pp. 293-307

CHAPTER XXV. Ocular Disease in the Gouty

OCULAR DISEASE IN THE GOUTY

Evidence of Gout in the Eye. Deposition of Urates. Gouty Diathesis. Significance and Location of Tophi. Relative Incidence of Iritis. Metastasis. Arthritic Iritis. Gouty Iritis not a Clinical Entity. Ocular Symptoms in Hyperuricæmia. False Gout. Retinal Hæmorrhage. Neuro-retinitis. Glaucoma. Conclusions pp. 308-326

CHAPTER XXVI. Treatment of Gout

TREATMENT OF GOUT

Radical Treatment of Local Foci of Infection or Toxic Absorption. Diet in Acute and Chronic Gout. The Fallacy of Fixed Dietaries. Thorough Physical Examination a necessary Prelude to Dieting. Need for Collaboration of Clinician and Bio-chemist pp. 327-341

CHAPTER XXVII. Treatment of Gout (_continued_)

TREATMENT OF GOUT (continued)

Regulation of Diet in the Gouty. The Individual Foodstuffs, Proteins, Carbohydrates, Fats, Vegetables, Fruits, Condiments. Special Dietaries. Amylaceous Dyspepsia. Hyperchlorhydria pp. 342-371

CHAPTER XXVIII. Medicinal and Other Modes of Therapy—Acute Gout

MEDICINAL AND OTHER MODES OF THERAPY—ACUTE GOUT

Initial Purgation. Colchicum in Acute Gout. Method of Administration. Preparations and Dosage. Colchicine, Salicylate of Colchicine. Atophan. Alternative Remedies in Acute Gout. Salicylates. Alkalies. Quinine. Thyminic Acid. Anodynes in Acute Gout. Local Measures. Analgesics. Liniments, etc. Ionisation. Massage. Surgical Methods pp. 372-388

CHAPTER XXIX. Medicinal and Other Modes of Therapy

MEDICINAL AND OTHER MODES OF THERAPY (continued)—INTER-PAROXYSMAL PERIOD

Prophylactic Measures. Treatment of Atonic Dyspepsia. Hyperacidity due to Organic Acids. Treatment of Hypochlorhydria. Alkalies, Atophan, and Colchicum as Prophylactics pp. 389-396

CHAPTER XXX. Medicinal and Other Modes of Therapy (_continued_)—Chronic

MEDICINAL AND OTHER MODES OF THERAPY (continued)—CHRONIC ARTICULAR GOUT AND ASSOCIATED MORBID CONDITIONS

Alkalies. Contrasts between Salts of Sodium and Potash. Differential Indications for their Usage. Alternatives. Salicylates. Benzoates. Hexamine. Iodides. Iodine. Albumen Compounds. Collosol Preparations of Iodine. Guaiacum. Local Measures in Chronic Articular Gout. Treatment of Tophi. Ionisation. Surgical Measures. Treatment of Associated Morbid Conditions. Fibrositis. Lumbago. Sciatica. Acute Brachial Fibrositis. Local Massage. Oxaluria. Glycosuria. Hyperchlorhydria. Gouty Phlebitis. Gouty Eczema. Gouty Nephritis pp. 397-417

CHAPTER XXXI. Climato-Therapy, Hydro-Therapy, Etc.

CLIMATO-THERAPY, HYDRO-THERAPY, ETC.

Climate. Choice of Residence. Clothing. Exercise. Massage. General Hydro-therapy. Importance of thorough Physical Examination. Individual Reactive Peculiarities. Prophylactic Measures. Contra-indications and Untoward Complications. Methods of Application of General Hydro-therapy. Immersion Baths. Aix and Vichy Massage. Vapour Baths. Indications for Sub-thermal Baths. Local Hydro-therapy. Varieties of Douche. Treatment by Hyperæmia pp. 418-430

CHAPTER XXXII. Mineral Springs and Choice of Spa

MINERAL SPRINGS AND CHOICE OF SPA

Difficulties of Definition and Classification. Radio-activity. General Principles of Spa Treatment. Physiological Action of Radium Emanation. Activation of Body Ferments. Influence of Uric Acid Metabolism. Increased Excretion of Uric Acid. Subjective Phenomena of Gout in Relation to Blood Content and Excretion of Uric Acid. Therapeutic Action and Application. Alimentary Disorders. Glycosuria. Raised Blood Pressure. Choice of Spa. The Spare and the Obese. Waters Suitable for Various Types of Dyspepsia. Bickel’s Experiments. Mineral Waters in Associated Morbid Conditions. Glycosuria. Oxaluria. Phlebitis. Respiratory Disorders. Fibrositis. Gouty Eczema. Uric Acid Gravel. Arterio-sclerosis. Chronic Nephritis. Concluding Remarks on Spa Treatment pp. 431-465

INDEX pp. 457-469

CHAPTER I. Historical and Introductory

HISTORICAL AND INTRODUCTORY

THE ANTIQUITY OF GOUT

“Teeth, bones, and hair,” quoth the Sage of Norwich, “give the most lasting defiance to corruption,” and were it not that “Time which antiquates antiquities and hath an art to make dust of all things hath yet spared these minor monuments,” it might perhaps have been inferred that gout was the primordial arthritic disease that afflicted mankind.

That it was the first articular affection to achieve clinical individuality may be allowed, but, from the aspect of antiquity, gout is relatively modern—the appanage of civilisation. True, Hippocrates, discoursing in the famous Asclepion at Cos, enunciated his aphorisms on gout some 300 years before the Christian Era, the dawn of which moreover found Cicero in his discussions at Tusculum lamenting its excruciating tortures “doloribus podagræ cruciari” and the peculiar burning character of its pains “cum arderet podagræ doloribus.”

But what of that? For did not Flinders Petrie in the hoary tombs of Gurob (dating back to the 28th Dynasty 1300 B.C.) find in mouldering skeletons of bygone civilisations unequivocal evidence of osteoarthritis. But despite these sure though silent witnesses of the prevalence of this disorder among the ancient people of Egypt, yet in contrast with gout, no hint transpires in the writings of Greek or Roman physicians, nor those of much later date, that the condition was recognised clinically, as a joint disorder, distinct from others of the same category.

Small call to marvel thereat, for how much more arresting the clinical facies of gout, with its classic insignia—tumor, robor, calor, et dolor—than of osteoarthritis, its etiolate tokens indicative rather of infirmity than of disease. Apart from this, it may well be that the early Egyptians owed their relative immunity from gout, and alike their proneness to osteoarthritis, to living hard laborious days, unenervated by that luxury and sloth, which in the first century A.D. drew upon the ancient Romans the caustic reproofs of Pliny and Seneca. For the old philosophers lamented the growing prevalence of the disorder, almost unknown in the early, more virile days of the Empire, rightly seeing in it but another harbinger of impending decadence, clearly attributable as it was to riotous living and debauchery.

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