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Symptomatology of Gout

arthritic, history, articular, children, arthritism, family, predisposition and instances

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Before passing to the consideration of the symptoms of an acute attack of articular gout, it is important to know its antecedents ; in a word, to recognize the signs that characterize the arthritic diathesis.

By this term is meant a predisposition to a certain class of disorders and diseases that are naturally related to each other. The predis position is usually inherited, but it may be also acquired. The signs of a diathetic tendency are not always well marked, but in many instances their array is complete, and as conclusive as an articular attack itself could be. Often, however, only one or two marks of the tendency are apparent, and, especially among children, the scattered evidences need the support of a definite family history in order to render them instructive. They should never be overlooked, for'in many doubtful cases they may furnish the clue to a most sug gestive and fruitful line of inquiry.

One cannot be too often reminded of the fact that the existence of a cliathetic predisposition is incompatible with perfect well-being. The individual may appear to be in the enjoyment of blooming health; his color is high, his flesh is firm and abundant, lie is continually in the receipt of congratulations upon his vigor of mind and body. Despite all this, a careful physical examination will never fail to re veal some departure from the normal standard long before the out break of an acute attack of the disease. In many instances, where the habits of life and the diet preclude all possibility of articular inflammation, the evidences of abarticular or irregular gout may be discoverable. It is thus that among children the proof of arthritism may be often gathered from the concurrence of a suspicious family history and certain skin diseases that are not in themselves specially significant. Unless guided by a characteristic family history, it is often difficult to decide whether certain unhealthy manifestations in infancy.should classify the patient as arthritic or scrofulous.

Among the earliest manifestations of infantile arthritism is the frequent occurrence of indigestion. The child may be fat and hearty, blessed with the best of appetites, yet subject to colic and constipa tion, or looseness of the bowels. The face and scalp are disfigured by an obstinate and intensely painful eczema. The eruption may be either dry or moist, and it itches frightfully, so that the hands have to be tied in order to prevent scratching. Yet there is nothing

pathoguomonic about this eruption. It is its obstinacy, its concur rence with other arthritic disorders, and a bad family history that serve to classify it among the precursory phenomena of arthritism.

We are not yet in a position to distinguish infallibly between the two great diatheses, the arthritic and the scrofulous.

Besides eczema, the teething infant is prone to other itching eruptions. Urticaria, erythema, lichen, and various unclassifiable pruriginous irritations of the skin may occur without any apparent cause. They seem to be dependent upon an excessive sensitiveness of the cutaneous tissues that permits them to experience morbid excitement from causes that are insufficient to arouse the correspond ing structures in a healthy body.

In like manner the mucous surfaces of the internal passages ex hibit similar irritability. The slightest exposure to a draught or clamp air causes the patient to " take cold." Coryza, pharyngeal catarrh, laryngitis, laryngismus stridulus, bronchitis may follow each other in quick succession or may concur with alarming facility. But these inflammations are usually of short duration, and do not dis play the persistent tendency to tedious muco-purulent discharge that characterizes similar affections in a scrofulous child. Inspection of the throat more frequently reveals a chronic granular pharyngitis rather than the indolent tonsillar hypertrophy that belongs to scrofula.

Another manifestation of the gouty predisposition is sometimes witnessed in the form of headache. This assumes the form of period ical and recurrent headache—usually described as hemicrania or migraine. It is usually encountered among the children of parents one or both of whom have suffered with the same malady. In one in stance that came under my observation the record of migraine could be traced back, over a line of gouty ancestors, for a period of four hundred years. Cases are not uncommon among children of six or seven years—sometimes as early as three,—giving occasion at this early age for anxiety regarding the possibility of tubercular menin gitis as the exciting cause of the headache and vomiting that are so violent and exhausting. In many instances these recurrent headaches form the only conspicuous evidence of arthritism during early and middle life, if the habits of the patient do not provoke the character istic articular lesions.

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