Sir William Roberts defines gout “as a constitutional disorder characterised by paroxysmal attacks of inflammation of the joints, associated with the formation of chalk-like concretions in and about the joints.”

Sir William Osler regards gout as “a nutritional disorder, one factor of which is an excessive formation of uric acid, characterised clinically by attacks of acute arthritis, by the gradual deposition of urate of soda in and about the joints, and by the occurrence of irregular constitutional symptoms.”

For myself, I would proffer the following definition, which, of course, the reader must accept provisionally, viz., pending the perusal of subsequent chapters, dealing with the pathology and clinical features of gout, and the inferences drawn therefrom as to the nature of the disease.

Definition.—Gout is an hereditary disorder, the intrinsic element of which is an inborn instability of nuclein metabolism which may remain latent, but under the influence of extrinsic factors, infections, becomes manifest, as betokened by local inflammatory tissue reactions in joints or elsewhere the specific character of which is attested by the associated uratic deposition.

Classification

At the present time, under the most liberal interpretation, the word “gout” comprises the following conditions, viz., acute and chronic articular gout, and the so-called ab-articular forms. But it is clear that not only the latter or irregular manifestations, but even the former or regular varieties of the disorder seem destined to undergo considerable pruning.

As to the classical podagra—acute articular gout—no question can arise as to the propriety of its retention in this category. But as to the chronic articular types we are on less certain ground, and to discussion of this vexed question we now proceed.

Let us take, for example, Sir Dyce Duckworth’s classification of the arthritic types of gout. He distinguishes the following forms:—

the latter (2) further subdivided into—