For the section dealing with the ocular disorders met with in the gouty my most sincere thanks are due to Mr. W. M. Beaumont, of Bath, whose singularly wide experience in this sphere renders him unusually equipped to deal with this highly controversial aspect of gout. To Drs. Cave and Gordon, of Bath, also I am indebted for many valuable suggestions kindly afforded me while writing this volume. To my brother Dr. Bassett Jones I am under deep obligation for unwearying assistance in our joint endeavour to ascertain the exact relationship of gout to lumbago, sciatica, and other types of fibrositis.

For the preparation of the index of this work I would proffer my grateful thanks to Mr. Charles Hewitt and to Miss Donnan and Miss Crosse for having undertaken the arduous task of typing the manuscript thereof.

Lastly, I would express my thanks to my publisher, Mr. Heinemann, for much consideration and many courtesies.

LL. J. LL.

31, Upper Brook Street, W. 1.

TABLE OF CONTENTS

CHAPTER I
HISTORICAL AND INTRODUCTORY
The Antiquity of Gout. Prevalence of Gout in the Anglo-Saxon Period. Views of the Humoralist. The Aphorisms of Hippocrates. Introduction of the Word Gout. Early Views as to the Nature of Tophi. The “Honour of the Gout.” That Gout confers Immunity from other Disorders. Growing Infrequency and Attenuation of Gout[pp. 1-13]
CHAPTER II
THE PEDIGREE OF GOUT
Tardy Dissociation of Chronic Gout. Identification of Muscular Rheumatism. Differentiation of Chronic Gout from Arthritis Deformans. Cleavage of Arthritis Deformans into Two Types. Elimination of the Infective Arthritides[pp. 14-20]
CHAPTER III
EARLIER THEORIES OF PATHOGENESIS
Garrod’s Theory. Antagonistic Views. Histogenous Theories. Antecedent Structural Changes. Hepatic Inadequacy. Hyperpyræmia. Nervous Theories. Growing Scepticism as to Garrod’s Pathogeny of Gout[pp. 21-34]
CHAPTER IV
DEFINITION, CLASSIFICATION, ETIOLOGY, AND MORBID ANATOMY
Definition. Classification. Suggested Classification of Articular Gout. Etiology and Morbid Anatomy. Bodily Conformation and Individual Temperament. Locality, Race, Climate. Food, Drink, Occupation. Lead Poisoning. Mental and Physical Over-exertion. Summary. Morbid Anatomy[pp. 35-58]
CHAPTER V
PATHOLOGY OF GOUT-PROTEIN METABOLISM
Revelations of the Bio-chemist. The Formation of Urea. Fate of the Amino-acids. Seat of Formation of Urea. Amino-acids in Relation to Gout. The Glycocoll Theory of Gout. Urea Excretion in Gout. Creatine and Creatinine. Inborn Errors of Metabolism[pp. 59-70]
CHAPTER VI
NUCLEIN METABOLISM
The Isolation of Nucleic Acid. Researches on Spermatozoa. The Discovery of Purins. Uric Acid a Derivative of Nucleic Acid. The Chemistry of Uric Acid and the Purin Bodies. Chemical Constitution. Properties of Uric Acid. Uric Acid in the Blood. Gudzent and Schade’s Theories. Organic Combinations. Complexity of the Problem[pp. 71-82]
CHAPTER VII
SOURCES OF URIC ACID
Exogenous Purins. Exogenous Uric Acid Excretion. Fate of the Unexcreted Purins. Endogenous Purins. Source of Endogenous Purins. Proteins and their Derivatives. Amino-acids and Dicarboxylic Amino-acids. Endogenous Uric Acid Excretion. Factors influencing Endogenous Uric Acid Excretion. Physiological Conditions. Pathological States. Ingestion of Certain Drugs. Synthetic Formation of Uric Acid[pp. 83-97]
CHAPTER VIII
FORMATION AND DESTRUCTION OF URIC ACID
Distribution of the Enzymes. Stages in Disruption of Nucleic Acid. Destruction of Uric Acid[pp. 98-106]
CHAPTER IX
URIC ACID IN RELATION TO GOUT
Uric Acid Excretion in Gout. Uric Acid Variations in Acute Gout. Uric Acid Variations in Chronic Gout. Retarded Exogenous Uric Acid Output. Lowered Endogenous Uric Acid Output. Other Anomalies in Excretion in Gout. Purin Metabolism in other Disorders. Purin Metabolism in Chronic Alcoholism and Plumbism[pp. 107-116]
CHAPTER X
THE RENAL THEORY OF GOUT
Anomalies in Uric Acid Excretion in Gout. Uricæmia in Nephritis. The Relationship, if any, between the Amounts of Uric Acid and of Urea, and Total Non-protein Nitrogen in Human Blood. Uricæmia not necessarily due to Renal Defect. Uricæmia not Peculiar to Nephritis. Uricæmia does not necessarily Portend Gout. To what may be ascribed the Deficient Eliminating Capacity of the Kidney for Uric Acid. Uratic Deposits in Nephritis. Differentiation of Uratic Deposits in Gout and Nephritis. Clinical Associations of Gout and Granular Kidney[pp. 117-132]
CHAPTER XI
URICÆMIA IN GOUT
Folin and Denis’s Method. Uric Acid a Normal Constituent of Blood. Effect of Exogenous Purins. Uric Acid Content of Blood in Gout. Hyperuricæmia in Non-gouty Arthritis. Variations in Uric Acid Content of Blood independently of Diet. What Relationship, if any, Exists between the Uric Acid Content of the Blood and Attacks of Gout. Discussion of the Foregoing Data. The Significance of Uricæmia. Sources of Fallacy in Uric Acid Estimation. Disabilities of Modern Tests. Need for further Investigations[pp. 133-148]
CHAPTER XII
URATOSIS IN RELATION TO GOUT
Constitution of Tophi. Mode of Formation. Localisation of Uratic Deposits. The Causation of Tophi. Solubilities of Uric Acid. Tophi in Relation to Uricæmia. Tissue Affinities for Uric Acid. Retention Capacity of Tissues for Uric Acid. Clinical Evolution of Tophi. The Cause of the Inflammatory Phenomena. Non-toxicity of Uric Acid. Are the Precursors of Uric Acid Toxic?[pp. 149-170]
CHAPTER XIII
THE RISE OF THE INFECTIVE THEORY
Boerhaave’s Forecast of the Infective Theory. Ringrose Gore on Infective Origin. Leucocytosis in Acute Gouty Polyarthritis. Chalmers Watson’s Researches on Gout in a Fowl. Trautner’s Suggestion of a Specific Infection[pp. 171-176]
CHAPTER XIV
GOUT AS AN INFECTION
Local Foci of Infection: Dental, Nasal, Pharyngeal, etc. Gastro-intestinal Disorders. Variation in Free HCL. Intestinal Disorders. Infection or Sub—infection[pp. 177-187]
CHAPTER XV
GOUT AS AN INFECTION (continued)
Analysis of the Acute Paroxysm. The Evolution and Life History of Gout. Analogies between Gout and the Specific Infective Arthritides. Correlation of the Metabolic Phenomena of Gout with the Postulated Infective Element[pp. 188-199]
CHAPTER XVI
CLINICAL ACCOUNT
Acute Localised Gout. Prodromal Symptoms. Dyspepsia. Premonitory Symptoms of Tophus Formation. Premonitory Articular Pains. The Acute Paroxysm. Detailed Consideration of Phenomena. Mode of Onset. Localisation. Nature of Pain. General Phenomena. Pyrexia. Changes in the Blood. Uric Acid Excretion. Local Phenomena. Tophus Formation[pp. 200-213]
CHAPTER XVII
CLINICAL ACCOUNT (continued)
Acute Gouty Polyarthritis. Mode of Invasion. Distribution of Lesions. Local Characters. Constitutional Symptoms. Changes in the Blood. Leucocytosis. Collateral Phenomena of Gout. Lumbago, Sciatica, etc. Incidence of Gouty Stigmata in Various Types of Fibrositis[pp. 214-224]
CHAPTER XVIII
CLINICAL ACCOUNT (continued)
Chronic Articular Gout. The Joint Deformities of Chronic Gout. Tophi: Their Evolution and Distribution. Other Sites of Tophi. Affinities between Gout and other Diseases. Gout in Relation to Glycosuria. Gout in Relation to Phlebitis. Cutaneous Disorders. Gout and Nephritis. Prognosis in Gout[pp. 225-246]
CHAPTER XIX
ETIOLOGICAL AND CLINICAL DIAGNOSIS.
Articular Gout. Etiological Diagnosis. Clinical Diagnosis. Introductory Remarks. The Diagnostic Status of Tophi. Tophi in Relation to Arthritis. Frequency of Tophi in True Gouty Arthritis Underestimated. Difficulty of Detecting Tophi[pp. 247-257]
CHAPTER XX
CLINICAL DIAGNOSIS (continued)
Acute Articular Gout. Localised Variety. Differential Diagnosis. Infections. Acute Gonococcal Arthritis. Traumatic Lesions. Acute Osteoarthritis. Static Foot Deformities. Hallux Valgus with Inflamed Bunion. Hallux Rigidus. Metatarsalgia. Gout in the Instep. Gonococcal Arthritis. Tuberculosis and Syphilitic Disease of the Tarsal Joints or the Related Joints. Pes Planus. Gout in the Heel. Referred Pain. Local Sources of Fallacy. Post-calcaneal Bursitis. Synovitis of the Tendo Achillis. Gout in the Sole. Plantar Neuralgia. Erythromelalgia. Anomalous Sites for Initial Outbreaks[pp. 258-267]
CHAPTER XXI
CLINICAL DIAGNOSIS (continued)
Acute Gouty Polyarthritis. Differential Diagnosis. Acute Articular Rheumatism. Acute Gonococcal Arthritis. Etiology. Onset. General Symptoms. Distribution of Lesions. Local Characters. Associated Phenomena. Secondary Syphilitic Arthritis. Acute Rheumatoid or Atrophic Arthritis. Age and Sex. Onset. General Symptoms. Distribution of Lesions. Local Characters. Associated Phenomena. Infective Arthritis of Undifferentiated Type[pp. 268-274]
CHAPTER XXII
CLINICAL DIAGNOSIS (continued)
Chronic Articular Gout. Chronic Monarticular Gout. Monarticular Gout in Large Articulation a Rarity. Chronic Gout of Oligo-articular Distribution. Its Confusion with Chronic Villous Synovitis. Villous Synovitis Static and Non-gouty in Origin. Clinical Symptoms of Villous Synovitis. Bilateral Hydrarthrosis. Peri-synovial and Peri-bursal Gummata. Chronic Gout of Polyarticular Distribution. Differential Diagnosis. Osteoarthritis. Local Characters of Joint Swellings. Rheumatoid Arthritis. Local Characters of Joint Swellings. Nerve Arthropathies. Hæmophilic Arthritis[pp. 275-285]
CHAPTER XXIII
CLINICAL DIAGNOSIS (continued)
Skiagraphy. Significance of Local Areas of Rarefaction. The Radiographic Types of Gouty Arthritis. Differential Diagnosis. Infective Arthritis. Hypertrophic or Osteoarthritis. Rheumatoid or Atrophic Arthritis[pp. 286-292]
CHAPTER XXIV
IRREGULAR GOUT
Historical Account. Murchison’s Views. Retrocedent Gout. Gout in the Stomach. Cardiac and Cerebral Forms. Other Irregular Manifestations. Conclusions. Infantile Gout[pp. 293-307]
CHAPTER XXV
OCULAR DISEASE IN THE GOUTY
Evidence of Gout in the Eye. Deposition of Urates. Gouty Diathesis. Significance and Location of Tophi. Relative Incidence of Iritis. Metastasis. Arthritic Iritis. Gouty Iritis not a Clinical Entity. Ocular Symptoms in Hyperuricæmia. False Gout. Retinal Hæmorrhage. Neuro-retinitis. Glaucoma. Conclusions[pp. 308-326]
CHAPTER XXVI
TREATMENT OF GOUT
Radical Treatment of Local Foci of Infection or Toxic Absorption. Diet in Acute and Chronic Gout. The Fallacy of Fixed Dietaries. Thorough Physical Examination a necessary Prelude to Dieting. Need for Collaboration of Clinician and Bio-chemist[pp. 327-341]
CHAPTER XXVII
TREATMENT OF GOUT (continued)
Regulation of Diet in the Gouty. The Individual Foodstuffs, Proteins, Carbohydrates, Fats, Vegetables, Fruits, Condiments. Special Dietaries. Amylaceous Dyspepsia. Hyperchlorhydria[pp. 342-371]
CHAPTER XXVIII
MEDICINAL AND OTHER MODES OF THERAPY—ACUTE GOUT
Initial Purgation. Colchicum in Acute Gout. Method of Administration. Preparations and Dosage. Colchicine, Salicylate of Colchicine. Atophan. Alternative Remedies in Acute Gout. Salicylates. Alkalies. Quinine. Thyminic Acid. Anodynes in Acute Gout. Local Measures. Analgesics. Liniments, etc. Ionisation. Massage. Surgical Methods[pp. 372-388]
CHAPTER XXIX
MEDICINAL AND OTHER MODES OF THERAPY (continued)—INTER-PAROXYSMAL PERIOD
Prophylactic Measures. Treatment of Atonic Dyspepsia. Hyperacidity due to Organic Acids. Treatment of Hypochlorhydria. Alkalies, Atophan, and Colchicum as Prophylactics[pp. 389-396]
CHAPTER XXX
MEDICINAL AND OTHER MODES OF THERAPY (continued)—CHRONIC ARTICULAR GOUT AND ASSOCIATED MORBID CONDITIONS
Alkalies. Contrasts between Salts of Sodium and Potash. Differential Indications for their Usage. Alternatives. Salicylates. Benzoates. Hexamine. Iodides. Iodine. Albumen Compounds. Collosol Preparations of Iodine. Guaiacum. Local Measures in Chronic Articular Gout. Treatment of Tophi. Ionisation. Surgical Measures. Treatment of Associated Morbid Conditions. Fibrositis. Lumbago. Sciatica. Acute Brachial Fibrositis. Local Massage. Oxaluria. Glycosuria. Hyperchlorhydria. Gouty Phlebitis. Gouty Eczema. Gouty Nephritis[pp. 397-417]
CHAPTER XXXI
CLIMATO-THERAPY, HYDRO-THERAPY, ETC.
Climate. Choice of Residence. Clothing. Exercise. Massage. General Hydro-therapy. Importance of thorough Physical Examination. Individual Reactive Peculiarities. Prophylactic Measures. Contra-indications and Untoward Complications. Methods of Application of General Hydro-therapy. Immersion Baths. Aix and Vichy Massage. Vapour Baths. Indications for Sub-thermal Baths. Local Hydro-therapy. Varieties of Douche. Treatment by Hyperæmia[pp. 418-430]
CHAPTER XXXII
MINERAL SPRINGS AND CHOICE OF SPA
Difficulties of Definition and Classification. Radio-activity. General Principles of Spa Treatment. Physiological Action of Radium Emanation. Activation of Body Ferments. Influence of Uric Acid Metabolism. Increased Excretion of Uric Acid. Subjective Phenomena of Gout in Relation to Blood Content and Excretion of Uric Acid. Therapeutic Action and Application. Alimentary Disorders. Glycosuria. Raised Blood Pressure. Choice of Spa. The Spare and the Obese. Waters Suitable for Various Types of Dyspepsia. Bickel’s Experiments. Mineral Waters in Associated Morbid Conditions. Glycosuria. Oxaluria. Phlebitis. Respiratory Disorders. Fibrositis. Gouty Eczema. Uric Acid Gravel. Arterio-sclerosis. Chronic Nephritis. Concluding Remarks on Spa Treatment[pp. 431-465]
INDEX[pp. 457-469]