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Irregular Gout - Abarticular Gout

articular, visceral, disease and internal

IRREGULAR GOUT - ABARTICULAR GOUT.

Much discussion has arisen over the possibility of gouty manifes tations affecting the internal viscera, either in alternation with or as a substitute for the articular localizations of the disease. With characteristic acuteness of observation the older physicians insisted upon the possible retrocession of articular symptoms and their trans fer to an internal organ. Thus a suppression of swelling and pain in the great toe might be immediately succeeded by an asthmatic attack, or by abdominal distress. This is known as retrocedent gout. Conversely, individuals who have suffered long with acid dys pepsia or other visceral disorders find themselves cured of this ail ment by the development of an articular inflammation. With the disappearance of articular symptoms the visceral disturbances re appear, constituting what is described as masked gout.

When these different manifestations of disease present themselves thus intimately connected, there can be little doubt of their common origin. But, in order to establish such a relationship beyond cavil, it is necessary to determine the fact of actual experience of gout, either in the person of the sufferer or of his progenitors. Mere experience of acid dyspepsia, of periodical headache, or of any other of the allied disorders, is not sufficient to warrant the assumption of the term ina.sea you'. These symptoms must occur in the person of a member of a gouty family, or they must be dissipated by the appear ance of articular disease, before they can be assigned to that rank. As

to the phenomena of retrocedeott gout, there can be scant space for uncer tainty when the sudden and premature subsidence of articular inflam mation is immediately followed by violent disorder in an internal organ. The dangers that attend such retrocession are usually deter mined by the location and intensity of the disturbance that is thus transferred from the merely locomotive organs to the vital structures of the body.

The possibility of masked forms of abarticular or visceral gout is now generally admitted. In many instances these visceral manifes tations exist for many years before the appearance of articular disease, and, apart from a history of heredity, constitute the only indications of the arthritic diathesis. In many instances, also, when the causes that lead to articular crises have been avoided by the practice of temperance and wholesome living, visceral accidents may throughout the whole of life recur in periodical fashion, and may never be replaced by the acute or chronic articular forms of gout. This attenuated gout is not uncommon among the temperate descendants of a gouty ancestry, and its phenomena have been described as the consequences of /ithcemict, a euphemism that appears to have been invented for the purpose of sparing the morbid sensibility of the patients.