(3) The said organism or organisms excite inflammatory reaction with sequential uratic deposition, either of articular or ab-articular site.
(4) The predilection of such uratic deposition for certain particular tissues is determined by their greater content of sodium ions as compared with the blood.
(5) The local and general phenomena of gout, its paroxysmal nature and tendency to periodicity, are most readily explicable on the basis of a chronic infection supervening in a subject the victim of those innate peculiarities of tissue with their correlated obliquities of function which connote what we term the “gouty diathesis.”
CHAPTER XVI
CLINICAL ACCOUNT
Acute Localised Gout
If we would clarify somewhat the obscurity that enshrouds the genesis of disease, our watchword must here, as in other spheres, be “Despise not the day of small things.” We know not the proximate cause of gout, it is true, nor the exact modus operandi of those agents, infective or other, which bring to fruition the latent morbid potentialities of its victims. But, even if so handicapped, we should be quick to descry those portents of the coming storm, those minor backslidings from physiological righteousness, that doubtless foreshadow the outbreak of the disorder.
For it cannot be doubted that the evil potentialities which make for gout are for long in operation before their definite installation in its chosen seat, the joints, ensues. As Trousseau puts it, “The diathesis is in action before there is time for the local affection to show itself in a precise form.” In short, given imminence of an attack, the whole system is charged with gout, or, as Sydenham laconically expressed it, “Totum corpus est podagra.”
Prodromal Symptoms
While we recognise that local inflammatory reaction in the joints is more particularly characteristic of gout, it is no less necessary that we take cognisance of the general precursory symptoms that often, if not always, usher in its onfall. Gout begins in a disorder of function.