Gout, with a section on ocular disease in the gouty

by Llewellyn J. Llewellyn

In conclusion, we would urge that, given gastric or hepatic disturbances, etc., in a subject predisposed by heredity or habits to gout, we should note the presence or absence of the following:—

(1) Pain, pricking, or tenderness in the ears, with or without small red swellings.

(2) Similar sensations at site of finger joints, with dorsal swellings over which the skin may be red or unchanged.

(3) The existence or not of pearly white concretions, i.e. mature tophi (as tested microscopically), at the above sites or elsewhere.

Further signs that may be sought for in cases of doubtful nature, i.e. unevidenced by tophi, would be:—

(4) The presence of uricæmia.

(5) A lowered or sub-normal output of uric acid in the urine.

(6) Diminution or retardation of the output of exogenous purin.

To take up the thread of our narrative regarding the prodromal symptoms which at any moment may give place to an articular outbreak. The determinants or exciting causes having been already dealt with in the section on etiology, we shall here only note those symptoms or signs that portend the imminence of the paroxysm. These are very variable. But it is suggestive if without any change in the habits the “dyspeptic” symptoms abate somewhat or disappear.