GOUT, the name rather vaguely given, in medicine, to a constitutional disorder which manifests itself by inflammation of the joints, sometimes with deposition of sodium biurate, and also by morbid changes in various important organs.
In all times this disease has engaged the attention of physicians, from its wide prevalence and the amount of suffering which it entails. Sydenham, the famous English physician of the 17th century, wrote an important treatise on the subject, and his description of the gouty paroxysm, all the more vivid from his having himself suffered for 34 years, is still quoted by writers as the most graphic and exhaustive account of the symptomatology of gout. Garrod, the most eminent authority on gout of recent times, distinguished regular gout, which affects the joints alone, and is either acute or chronic, from irregular gout, affecting non articular tissues, or disturbing the functions of various organs.
An attack of gout may come on without previous warning; but premonitory symptoms, especially in those who have previ ously suffered from the disease, are common. Among the more frequent of these are disorders of the digestive organs, feeble and capricious appetite, flatulence and pain, discomfort in the region of the liver and frequent micturition. These are accom panied by extreme irritability of temper, and various perverted sensations, such as that of numbness and coldness in the limbs. These symptoms may persist for many days and then undergo amelioration immediately before the impending paroxysm. On the night of the attack the patient retires to rest apparently well, but about two or three o'clock in the morning awakes with a painful feeling in the foot, most commonly in the ball of the great toe, but it may be in the instep or heel, or in the thumb.
The affected part is swollen and deep red. The overlying skin is tense and glistening, and the surrounding veins are distended. After a few hours there is a remission of the pain, slight per spiration takes place, and the patient may fall asleep. The pain may continue moderate during the day but returns towards night. These nocturnal exacerbations occur with greater or less severity during the continuance of the attack, which generally lasts for a week or ten days. As the symptoms decline the swelling and tenderness of the affected joint abate, but the skin over it pits on pressure for a time, and with this there is often associated slight desquamation of the cuticle. During the attacks the patient is restless and extremely irritable, and suffers from cramp in the limbs, dyspepsia, thirst and constipation. The urine is scanty and high-coloured, with a copious deposit, consisting chiefly of urates. During the attack the inflammation may leave one foot and affect the other, or both may suffer at the same time. After the attack is over the patient feels quite well, but it is rare that the first is the only attack of gout ; symptoms recur at ever shortening intervals. In the earlier recurrences the same joints suffer again, but in time others become implicated, until in advanced cases scarcely any articulation escapes. When gout assumes this form the attacks are usually less painful, but their effects are shown by disturbance of important organs, especially the stomach, liver, kidneys and heart, and by changes in the joints arising from the formation of so-called chalk-stones or tophi. These deposits, characteristic of gout, appear at first as a semi fluid material containing sodium biurate, which ultimately becomes hard and restricts movement of the joint. Any of the joints may be thus affected, but most commonly those of the hands and feet. The material is also deposited in tendon sheaths underneath the skin and periosteum, in the sclerotic coat of the eye, and espe cially on the cartilages of the external ear.
The recognition of what is termed irregular gout is less easy. In general the manifestations are those of lithiasis (see META BOLIC DISEASES). When chronic, gout is often associated with degenerative changes in the heart and large arteries and with chronic granular kidney. Less commonly the kidney is found to contain uric acid calculi ; the association of gout with gravel is well recognised.
Gout is a familial disease, but luxurious living and strong sweet wines on the one hand, and chronic lead poisoning on the other, are predisposing causes. Lack of adequate exercise also plays a part, and an attack sometimes may be warded off by a sharp walk.
Gout may also affect persons who observe the strictest temper ance in living, and whose only excesses are in the direction of over-work, either physical or intellectual. It is more common in mature age than in the earlier years of life, the greatest number of cases in one decennial period being between the ages of 3o and 4o, next between 20 and 3o, and thirdly between 4o and 5o. After middle life gout rarely appears for the first time. Women are less subject than men, and it most frequently appears after the menopause. Persons exposed to the influence of lead poison ing, such as plumbers, painters, etc., are apt to suffer from gout.
Attacks of gout are readily excited in those predisposed to the disease. Exposure to cold, disorders of digestion, fatigue, and injuries of particular joints will often precipitate the paroxysm.