Gouty Arthritis.
Note large tuberous swellings on knuckle and metacarpo-phalangeal joints due to uratic deposits.
GOUT
BY
LLEWELLYN JONES LLEWELLYN, M.B. Lond.
GOVERNOR AND SENIOR PHYSICIAN, ROYAL MINERAL WATER HOSPITAL, BATH;
FELLOW OF ROYAL SOCIETY OF MEDICINE; AUTHOR OF “ARTHRITIS DEFORMANS”;
CO-AUTHOR OF “FIBROSITIS”; CO-AUTHOR OF “MALINGERING, OR THE SIMULATION
OF DISEASE”; CO-AUTHOR OF “PENSIONS AND THE PRINCIPLES OF THEIR
EVALUATION”; CONTRIBUTOR TO LATHAM AND ENGLISH’S “SYSTEM OF TREATMENT,”
ALSO TO “OXFORD ENCYCLOPÆDIA OF TREATMENT” AND TO “STUDENT’S
TEXT-BOOK OF SURGERY.”
WITH A SECTION ON
OCULAR DISEASE IN THE GOUTY
BY
W. M. BEAUMONT
CONSULTING OPHTHALMIC SURGEON TO THE SOUTH-WESTERN
REGION OF THE MINISTRY OF PENSIONS; AUTHOR OF “INJURIES
OF THE EYES OF THE UNEMPLOYED, PROBLEMS IN PROGNOSIS,” ETC.
ST. LOUIS
C. V. MOSBY COMPANY
1921
Printed in Great Britain.
Dedicated
TO
MY WIFE
“A knowledge of the real nature of gout ... is, in myopinion, at the very foundation of all sound pathology,” wroteTodd many years since; and the passing years have but investedhis reflection with deeper significance and something of propheticinsight. For who can doubt that he who would elucidate thepathological groundwork of gout must be at once a clinicalphysician, a bio-chemist, a bacteriologist, a morbid anatomist?and well may we ask, Who is sufficient for all this?
How vivid the light thrown upon the problems of clinicalmedicine by the bio-chemists! The story of the fate of proteinand purin substances in the animal body, at one time a medley ofguesses and gaps, is gradually evolving into one of relative certitudeand completeness. Revolutionary, in truth, the change, andmany a cherished shibboleth has been ruthlessly cast aside!With admiration not unmingled with awe we see them layingwell and truly the foundations upon which in the ultimatescientific medicine must inevitably rest.
Of these the very corner-stones are chemical physiology andchemical pathology, the rapid evolution of which is profoundlyaltering our conceptions of health and disease. Those vital processesof the organism that but yesterday we saw “as through aglass, darkly,” are now in great part illumined, and the distortionswrought in them by disease made more manifest.
How pregnant, too, with warning their findings! Processesthat to our untutored minds seem simple are revealed as infinitelycomplex. Through what