But in many instances it is impossible to discover the local lesions that were just now indicated, and it is difficult to find uric-acid com pounds in the blood; yet the arthritic diathesis may be sufficiently conspicuous through the occurrence of disorders that belong to the arthritic group. It is, therefore, necessary to be familiar with their physiognomy in order to medicate them successfully, and to forewarn the patient against evils to which he is liable, if he depart from the necessary regimen. Such patients, though they may never have suf fered with articular inflammation, are subject to paroxysms of hem" crania, or asthma; they often exhibit patches of erythema and eczema; they are familiar with varicose veins, hemorrhoids, enteral gia, gastralgia, neuralgia of the heart and precordial nerves, dry and spasmodic cough, sneezing, acid dyspepsia, depression of spirits, insomnia, neurasthenia, all of which are determined by the permanent existence of the arthritic predisposition, and are allied by that com mon factor, as well as by their frequent alternation with the regular variety of the disease. Sometimes, especially as the years progress, the regular form of gout, by which the patient had been afflicted in earlier life, becomes suppressed, and in its place appear these irregu lar forms of the disease. Such abarticular manifestations are usually termed irregular gout, not because they furnish less characteristic exhibitions of arthritism, but because of their irregular incidence, coincidence, and sequence.
By the older physicians these forms of gout were often described as latent, suppressed, displaced, or metastatic cases of the disease.
They are sufficiently indicated by the term i•i•erpdar as contrasted with regular gout.
It is often convenient to speak of gout as being either acute or chronic. This division has its foundation in the fact that the par oxysm of regular gout is usually very severe, is attended by acutely inflammatory symptoms, runs a rapid course, and may be followed by a long intermission with freedom from painful disorder.
But in too many instances an acute attack may subside into chronic misery, in which the use of the terms acute and chronic is impossible without considerable confusion of ideas.
Besides this, it must never be forgotten that, DO matter how short and sharp the paroxysm, the predisposition upon which it rests is a chronic and permanent condition of ill-health.
Without attempting to give a definition that shall rise above criti cism, we may, therefore, speak of gout as the most conspicuous mani festation of a predisposition that is either hereditary or acquired, and is in both cases permanent during the remainder of life.
The disease may be either acute or chronic in the fluctuations of its course ; regular or irregular in its evolution.
Characterized, in acute and local varieties of the malady, by infil tration of the articular structures with compounds of uric acid, the tissues of the entire body may be finally either directly or indirectly ruined by kindred errors of nutrition. The progress of the disorder is marked by disturbances of sensation, motion, secretion, excretion, and nutrition that in acute cases reach the level of active local inflam mation accompanied by painful swelling, heat, and fever.