GOUT.
Synonyms.—Podagra; arthritis uri ca.
Definition.—Gout is a constitutional disease manifesting itself in various ways and attacking various tissues and parts of the body, but most frequently the ar ticulations. It occurs in an acute and a chronic form, both of which are charac terized by the deposit of orates in the affected parts.
Symptoms.—An attack of acute gout may occur without any precursory symp tom in persons who, before, felt quite well; but this mode of development is not usual. Generally, premonitory signs are experienced some time in advance, espe cially in the digestive and circulatory system and in the kidneys. The patients have frequently led a luxurious life, have been accustomed to excessive consump tion of food, especially of animal food, have indulged in alcoholic drinks, and taken little or no exercise. They are often obese. with red and flushed face, complain of heart-burn, sour eructations, flatulency, and other indications of a dys peptic derangement.
[Another form of gout—poor gout— is met with in persons living badly and exposed to cold and dampness; these patients are ordinarily lean. with sallow faces. F. T.,Evison] Immediately before an attack of acute gout the dyspeptic symptoms become aggravated; the bowels are obstinately confined; hemorrhoidal pain and haem orrhage is observed. The patients com plain of headache, vertigo, drowsiness; sleep is disturbed by pain or cramps in the calves and elsewhere; there is pain in various articulations; partesthetic sensa tions, such as numbness of the fingers, chilliness, etc.
Irregularity of the action of the heart is often observed and the pulse is ordi narily firm and tense; the morbid state of the nervous system manifests itself by mental depression, irritability, bad temper; severe neuralgia is a frequent precursory symptom, and severe pains of the lumbar region are frequently com plained of. In spite of all these manifes tations. the appetite is generally good and the venereal desire is frequently in creased. The urine is in most cases con
centrated and scanty; in others the mic turition is free, acid, and abundant, the urine being clear and watery. Just be fore the attack all the precursory symp toms commonly disappear and a general sense of well-being may be experienced.
Although some of these precursory symptoms are observed in most cases, an attack of gout may well occur without warning; when the first attack sets in the patient may believe that he suffers from a sprain of the affected joint or that the pain is of rheumatic nature and only by repetition of the attack does the real nninrn of 4hn rlizoncn 1,nporno nnnarnnf In the majority of cases of acute gout the metatarsal phalangeal joint of the great toe is the articulation first attacked; generally on one side, but sometimes on both; in subsequent attacks other articu lations become involved either of the foot (podagra) or of the hand (chiragra). Almost all articulations may successively or simultaneously be affected, even the articulations of the jaw and of the spine; the hip-joint and the shoulder-blade are very rarely affected.
The attack itself has been vividly de scribed by Scudamore, Sydenham, and other classics of gout: "The patient has gone to bed without any particular dis turbance of health and often feels better than for some time; after some hours' sleep he is awakened, ordinarily between 12 and 3 o'clock, by a very intense pain in the.great toe. The attack sometimes begins with a slight rigor. The pain soon increases to complete agony, there is much restlessness, and in vain some re lief is sought by changing the position of the foot. The patient complains of extreme tension and throbbing in the affected joint; the pain, which has been compared to that caused by a tightly drawn thumb-screw, is aggravated by the slightest touch or vibration, and becomes so intense that nothing at all like it oc curs in any other joint-disease.