The inadequacy of the uric acid theory of the causation of gout will then be discussed and the possible intrusion of an infective element in its genesis advocated. This accomplished, we shall proceed to the section dealing with the clinical aspects of the disorder, its regular and so-called irregular manifestations. Thence we shall proceed to the diagnosis of gout, while the terminal chapter will be devoted to that all-important subject—the prophylaxis and treatment of the affection.
CHAPTER IV
DEFINITION, CLASSIFICATION, ETIOLOGY, AND MORBID ANATOMY
Definition and Classification
Said Locke long since, “There are some words which will not be defined,” and surely of these is gout; for reflection upon the proffered definitions thereof is apt to leave one with the depressing impression that the disorder is both “incomprehensible and infinite.”
But have we not by unjustifiable and unwarrantable assumptions deliberately complicated the issue, in recklessly relegating to the gouty category a myriad affections of the intimate nature of which we are as ignorant as we are of gout? Doubtless, this is in part the outcome of a too slavish adherence to tradition, an undue reverence for authority. In all deference, our forefathers were somewhat too hasty in their speculations as to the causation of gout. Dominated by the prevalent philosophy of their days, they strove to interpret the phenomena of gout through its lights, endeavouring to reduce the study of its pathology to philosophical order when the very elements of philosophical order were lacking.
The same is reflected in the earlier, and to a lesser extent in the latter day definitions or descriptions, as some of them more aptly may be designated, notably that put forward by Sir Charles Scudamore.
“A constitutional disease, producing an external local inflammation of a specific kind; the susceptibility to it often depending on hereditary bodily conformation and constitution, but with great frequency wholly acquired; almost never occurring before the age of puberty, not frequently under the age of five-and-twenty, and most commonly between the ages of twenty-five and forty; affecting chiefly the male sex, and particularly persons of capacious chest and plethoric habit; in the first attack invading usually one foot only, and most frequently at the first joint of the great toe; but in its returns, affecting both feet or other situations, as the hands, knees, and elbows; and not only in the articular structure, but also in the other textures belonging to the moving powers, different parts being affected together or in succession; often accompanied with sympathetic inflammatory fever, which is usually marked by nocturnal exacerbations and morning remissions; much disposed to return at periodical intervals, and for the most part preceded by some premonitory symptoms.”
In extenuation of this prolixity, Scudamore observed that, “In an attempt to mark the general characters of gout, I feel the necessity of entering into a description rather in detail, instead of confining myself to a brief definition, because the disease is too complex in its nature to be distinguishable with certainty by a few signs alone.”
Trousseau, in his lectures on gout, refrains, perhaps wisely, from attempting any definitions of the disorder, resting content with the reflection that, “The production in excess of uric acid is a pathological phenomenon, inherent, like all others, in the disease, and, like all the others, it is dominated by a specific cause, which we know only by its effects, and which we term the gouty diathesis.”