550 DISEASES OF THE ORGANS OF LOCOMOTION. 



by the continued irritation of the deposits, after a time cause pain, dif- 

 ficulty of motion, and deformity of the affected joints during the inter- 

 val between the attacks. The patients often have difficulty in getting 

 about with the aid of a cane, and the usefulness of the hands and arms 

 is impaired if these be affected. In some cases, irritation of the sur- 

 rounding parts, by the concrements, induces phlegmonous inflamma- 

 tion. Abscesses form about the joint, and mortar-like masses, or firm 

 concrements, are not unfrequently mingled with the pus evacuated 

 from them. In proportion as the function of the limbs is gradually 

 impaired in chronic gout, the patient becomes infirm. The fulness of 

 body and strength are lost, and the digestion is impaired; the patient 

 suffers from acid stomach, flatulence and irregular bowels ; often, also, 

 there is disturbance of the circulation, and generally great irritability 

 and uneasiness. It is customary to refer the numerous disturbances 

 of function and nutrition that occur in the course of chronic gout to 

 the anomalous condition of the blood, or the gouty dyscrasia ; still it 

 is possible that an insidious fever, only to be recognized by the ther- 

 mometer, accompanies chronic gout, and induces the general cachexia. 

 As a rule, chronic gout results from the acute form, as we said above, 

 after the patient's constitution has suffered from repeated attacks of 

 the latter, or from debilitating treatment ; but cases also occur where 

 the disease is primary. 



Atonic or anomalous gout is the designation generally applied to 

 those forms where there is no actual attack of gout ; or, as the name 

 " atonic " indicates, where the debilitated organism is not in condition 

 to develop a normal attack of gout. Formerly the diagnosis of atonic 

 or anomalous gout was carried to excess ; but, on the other hand, it is 

 certainly going too far to class many of the symptoms, some of them 

 very peculiar, as accidental complications of the disease, and not 

 directly dependent on it. In persons who have previously suffered 

 from attacks of regular acute gout, we not unfrequently meet a con- 

 dition which we are perfectly justified in calling atonic gout. In such 

 patients there is a permanent constitutional affection, which shows 

 itself chiefly by excessive general hyperaesthesia, muscular weakness, 

 and dyspepsia, and usually also by an increased amount of perspira- 

 tion, and thick, cloudy urine. The most insignificant causes, such as 

 slight errors of diet, excitement, exposure to cold, changes of weather, 

 and often without perceptible cause, these constitutional symptoms 

 are accompanied by pains in one or more joints, which are very severe, 

 and resemble commencing attacks of gout. But there is only a mod- 

 erate redness and slight swelling, which disappear after a few hours ; 

 in other cases there is no redness or swelling, and the severe pain ia 

 the only indication of the gouty attack. If there have already beec 



