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Gout Definition

diathesis, arthritic, diseases, sometimes, disease, local and patient

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GOUT DEFINITION.

To formulate a concisely accurate definition of gout is impossible, for the reason that the disease is not a simple entity, but is both a local disorder and a general perversion of nutrition.

More than this—it is one of the most conspicuous manifestations of a particular diathesis. Gout belongs to that remarkable group of diseases in which the existence of ail individual tendency ou the part of the patient constitutes what is known as the arthritic diathesis.

By the term diathesis is signified not merely an hereditary or ac quired predisposition, but a predisposition to certain related diseases. The particular diseases that are grouped in the arthritic class are not so much related by location and community of symptoms a,s by th6 fact that they are, in some way that is not yet fully comprehended, connected with a disorder of nutrition which hinders the process of oxidation in the tissues. As a consequence of imperfect oxidation the liquids and the solids of the body become charged with products which represent, not the ultimate results of perfect oxidation, but rather the intermediate steps of the process. Instead of water, car bonic acid, and urea, as the only terminal products, there is an ex cessive formation of uric acid, fat, and the fatty acids; and sometimes there is a surplus of unoxidized sugar which is ejected as an unprofit able excretion. From the earliest ages this diathetic characteristic has been noted by every observer of gout, until it has become a settled conviction that gout is only a special manifestation of a ten dency which, modified by the varying conditions of life, results now in one, and again in another, of the different diseases that are united in the arthritic diathesis.

Their close relationship is still farther illustrated by the fact that the same patient may sometimes experience a number or all of them, either successively, alternately, or at the same time.

Thus it is not an uncommon clinical experience to witness in the same subject the simultaneous occurrence of baldness, pityriasis, ec zema, varicose veins, hemorrhoids, asthma, chronic catarrhal inflam mation of the mucous membranes, neuralgia, and some form of irregu lar gout or chronic rheumatism. Sometimes it is obesity and gout or

diabetes that are thus associated. Sometimes obesity exists in one generation, and is followed in the next by diabetes or by the gout; and the converse may also be witnessed.

Gout is, therefore, one of the forms in which the arthritic diathe sis may be individualized. But it is not merely a local disease of the joints marked by specific lesions. Nor is it only a general conse quence of an excessive accumulation of uric-acid compounds in the body. It is all this, and something more. It includes also the per version of nutrition—a perversion that does not proceed at random, but is based upon recondite constitutional peculiarities which may have been either hereditary or acquired, and are in conformity with certain, as yet undiscovered, processes of molecular chemistry.

We know that these processes may be induced by errors of diet and insufficient muscular exercise, but we do not know in what they ultimately consist. Three facts must therefore be considered in con nection with every example of gout : 1, The diathesis, with all its racial and constitutional affiliations ; 2, the chemical condition of the blood, overcharged with imperfectly oxidized compounds of nitrogen; 3, the local effects of the precipitation in and about the joints and other structures of such nitrogenous compounds, typically represented by sodium orates. These three factors may be all associated in the same individual; or one or more may be suppressed, giving origin, in the first place, to complete and typical examples of the disease, and to atypical, undeveloped, and irregular forms when suppression of certain fundamental characteristics has occurred. Thus, in the majority of acute cases of the disease, it is comparatively easy to demonstrate the diathetic peculiarities and tendencies of the patient. It is also an easy matter to find urates in the blood, and to note the local injury that results from infiltration of the joints and other tissues with the mineral deposit. Such cases constitute the regular, typical form of gout.

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