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Pathology - Gout

body, constitution, employed, temperament, term, word and structure

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PATHOLOGY - GOUT.

After this protracted survey we find ourselves again facing the inquiry, "What is gout? What is the nature of that change by virtue of which uric acid and its compounds are deposited in the tissues in stead of being harmlessly voided with the urine?" Gout has been de fined as the most conspicuous manifestation of the arthritic diathesis. It becomes necessary to further define some of these terms before pro ceeding to answer the previous inquiry.

The word diathesis is a term that has been long employed, and then discarded from medical literature by reason of a confusion of ideas associated with its use. Differently defined by different authors, and often vaguely employed to express various ill-known factors in the pathological field, many teachers have sought to eliminate obscurity by prohibiting the use of the word; consequently a certain amount of ill-deserved obloquy has fallen upon the term. But. properly defined and specifically employed, it does fill an im portant place in medical terminology ; and if to all minds it fails of conveying positive information, it will nevertheless indicate a clearly comprehensible dearth of knowledge regarding particular subjects. The term may be, therefore, used as a symbol that is significant of a given amount of knowledge and also of ignorance re garding the processes of nutrition in the living body.

It is admitted that the body is constituted by the association of a vast assembly of living cells. These are brought together by an in nate force that maintains them in definite relations with each other. According to the degree of perfection attained by the formative pro cesses will be the perfection of the resulting organization. The in dividual constitution is, therefore, the expression of the architectural force that operates in the formation of the body ; it is something that begins with the growth of the foetal germ, and that persists till the dissolution of the organism. It consists in the orderly arrangement of the elementary parts of an organic body in accordance with the type of structure that is characteristic of the class to which it be longs. It is transmitted from parent to offspring, so that the orig inal constitution is representative of the organization of the parental germs that have united in the impregnated ovum. But the con

stitution of the body may be modified by various incident causes that become operative during the course of life. A good constitu tion may become deteriorated by disease or injury, by starvation or poison, by disuse or fatigue. An originally feeble constitution may be invigorated and established upon a solid foundation by whole some food, proper clothing, medication, and shelter, and by the in telligent exercise of all the organs of the body. Examples of these processes of modification are every where apparent. We see the vigorous and healthy youth sinking under the influence of intemper ance and disease; and we are continually witnessing progress in the contrary direction from unhealthy infancy to robust and energetic manhood. All these observations serve to indicate that the constitu tion, though hereditary and persistent, is capable of modification in the was of improvement or deterioration.

But the word constitution is properly applicable to the structure only of the body. It is necessary to find a correlative term that may he employed to express the functional activity of the organism. Such a term is furnished by the word tenTermnent. Now, it is evi dent that in a complex structure, like the animal body, the move ments of its parts will depend upon the proportion and relation of those parts to each other. According to the predominant proportion of any given part will be the predominance of the movements effected by that part. The consequent peculiarity of movement, or function as it is called in the language of physiology, marks the temperament of the individual. Hence the old terms nervous temperament, san guine temperament, phlegmatic temperament, etc., employed to de note the predominance in the individual constitution of the nervous apparatus, of the circulatory and locomotive organs, of the fatty tissues, etc. But in the normally constituted body there is no special predominance of any given portion of the organism. With such a constitution, there is perfect harmony of action between all the organs of the body, and this fact is expressed by the phrase normal or healthy temperament.

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