The view that non-traumatic iritis is only a symptom imposes upon us a wide outlook in our search for a diagnosis. In this no viscus can be overlooked, no organ forgotten. All are members one of another, and the wise physician takes cognisance of their interdependence. The recognition of an inflamed iris is only the first stage in the diagnosis, for iritis is the sequel of a story written elsewhere. It is a question, not an answer.
But we know not what the future has in store, and though, with our present knowledge, I affirm that I can find no evidence that the eye is a locus signi for gout, the day may come when, either from bacteriological or other sources of progress, it may be shown that there is a mystic source of intercommunity. In other words, it may yet happen that the mysterious materies morbi of gout, whether microbic or chemical, may be demonstrated experimentally as capable of inducing, not only the arthritic phenomena, but also those inflammatory lesions in the eyes which provisionally are sometimes called “gouty.”
Lastly, I would enter a plea for more systematic, more scientific, investigation of the true link, if any, between iritis and arthritis. The war has taught us the value of “team-work”; it has taught us that the clinician must be reinforced by the bio-chemist, the bacteriologist and the pathologist. The work and the workers must be co-ordinated in our daily struggle with disease as we meet with it in our individual patients. The realm of medicine, with ever widening borders, is too vast for single control. In the foregoing pages I have said much about iritis, and it is a good example of what I mean. In justice to our patient, we may call for a Wassermann or a complement fixation test; we may require the teeth-roots made visible by an X-ray expert, or, it may be, the passage of a bismuth meal radiographed, hidden tonsils explored by the laryngologist, or the antrum illuminated; the fæces may need bacteriological examination. A gynæcologist may help us regarding a leucorrhœa or a possible ovarian abscess.
With many of our patients, alas! considerations of expense compel us to forego our aspirations.
What is the remedy? Is it not State help, central clinics staffed by highly trained experts engaged in research work? Here the poor could be examined and reports supplied to the attendant doctors free, and less impecunious patients at an inclusive fee. Centres such as these would do much to advance the science of medicine and thereby raise the standard of health and make the sick and ailing healthy citizens of a great empire.
Salus populi suprema lex.
CHAPTER XXVI
TREATMENT OF GOUT
Adaptation is the keynote to progress in therapy—adaptation of our therapeutic measures to the ceaseless advances of pathology. In the history of gout it has ever been so, the changing, oftentimes contradictory, vogues in treatment, always the reflex of equally mutable and conflicting views as to its pathogeny. For who can doubt that the facts of pathology supply the indices of rational as opposed to empirical methods of therapy?