Gout : what is its true aetiology?

Abstract

"Gout" says Duckworth, is a constitutional or diathet is malady, manifest in; . itself in very varied aspects. In its acute forms it usually, but not invari- ably, presents the characters of localised inflammation, accompanied_ by peculiarly intense pain; the inflammation in its course, and the attendant pain, being of a specif:.- ic nature. In its chronic forms there may be no mani- fest inflammatory features, and even no pain. The hiale sex, chiefly in the third decade, is most frequently the subject of the disorder in the acute form, and the articular system not seldom bears the brunt of its inci- de.r..ce . In the earlier manifestations the infla.:. atory trouble seizes eT ecially upon the first joint of the great toe, spreading subsequently to other articulations, and a suppurative stage but very rarely occurs. The digestive system is largely involved, and in the fully developed forms of the malady, hardly any of the viscera or textures are unaffected. The nervous system is likewise specially implicated- whether primarily or not is, as yet, a vexed question.

The disorder is either inherited, or newly acáuired. In most of its manifestations it is plainly associated with perturbed relations of uric acid in the economy, and the - inflammatory attacks are accompanied by deposits ofluca.te of sodium, for the most part .in articular cartilages and fibrous structures. A measure of pyrexia commonly forms part of the acuter gouty processes, but profound, though slow, nutritional changes may proceed Quietly in the chronic forms of the malady without any febrile movement".

tGoutl, writes Charcot", "is -a chronic and consti- tutional affection, most often hereditary, and always connected with a peculiar dyscrasic state ; for the pres- ence of an excess of uric acid in the blood constitutes one of the principal characters of the disease. It is incontestable that most of'the morbid manifestations which give to gout its peculiar physiognomy arise from this special condition:. this is the case, for example, with regard to the diseased joints But independently of these joint, affections, and of this special state of the blood, gout may give rise to numer- ous and varied visceral affections, sometimes structural, sometimes merely functional. There is even reason to think that, in some cases, rare however, the diathesis merely produces internal troubles of this kind during the whole evolution of the disease, without ever produc- ing those external manifestations on which we are accust- omed to reckon.

This is what old writers used to call irregular,as opposed to regular, gout, which corresponds to the classical type of the disease. yet, even in it we come across visceral disturbances; sometimes they appe «'r sud- denly in the midst of an attack (retrocedent gout. ), or in the interval (misplaced gout); sometimes, on the contrary, it is by a slow, progressive, almost latent, development, that those profound organic lesions are formed, which are so often met, with in gouty people. (Chronic Bright's, fatty heart.).

"Gout", says Woods Hutchinson, "may be defined as a toxaemia of varying causation, usually of gastro- intestinal origin, accompanied by the formation of an excess of urates, this excess of urates being due to the breaking down of the leucocytes and fixed cells in the attempt to neutralise the poison- in Other words, being the measure of the resisting power of the body tissues.

The formation and introduction of the toxins, be it well understood, are, by no means, confined to the gouty; it is only the nature of the resistance of the body to them that gives the character of gout."