GOUT. 53 



Forms of interstitial neuritis and of interstitial myositis are 

 also described in connection with rheumatism. Inflammation of 

 the sclerotic coat of the eye and of the iris may occur. 



Not only are the fibrous structures of the heart, such as the 

 valves and pericardium, liable to rheumatic inflammation, but 

 the myocardium may also be affected, and here it is said the 

 inflammation is not necessarily of interstitial or fibrous origin. 



GOUT. 



Clinically the likeness of acute polyarticular gout to acute 

 rheumatism is striking, and the lesions of chronic gout are 

 distributed in the body in a manner similar to those of the more 

 chronic forms of rheumatism. 



Gout not only manifests itself as an arthritis, but also invades 

 the cartilages and fibrous tissues of other parts of the body. 

 Such structures as ligaments, tendons, bursse, and the fibro- 

 cartilaginous helix of the ear, frequently suffer. More rarely 

 the sclerotic coat of the eye, the fasciae of the palms and soles, 

 the fibrous basis of the aortic and the mitral valves, the pericar- 

 dium, the laryngeal cartilages and the vocal cords, the tarsal 

 cartilages of the eyelids, the cartilages of the nose, the fibrous 

 sheaths of nerves, and even the cerebral and spinal membranes 

 are known to become the seats of uratic deposits. 



The gouty deposit in a joint first occurs a little beneath the free 

 surface of the cartilage and at a point near the centre ; it may be 

 inferred that in this position both the blood and lymph streams 

 are sluggish. The presence of synovia and of the fluid of tendon 

 sheaths, both of which contain an excess of sodium salts, is 

 believed by some to be an important factor in determining the 

 local deposit of urate of soda. 



As a rule gout first attacks the metatarso-phalangeal joint of 

 the great toe. Ais joint is subjected to considerable strain in 

 walking, entering as it does into the formation of the inner part 

 of the longitudinal arch of the foot ; in addition, it is near the 

 periphery of the circulation, and the arteries in gouty subjects 



