GOUT 



By W. EBSTEIN, Gottingen 



The words " GicM " and " Zipperlein " are genuine German words. The 

 former is the equivalent of the old English masculine " ghida," which means 

 " lodily pain in general." Zipperlein is the diminutive of " Zipper/' formed 

 from the verb " zippern," which in German means " jerhing, restless, trip- 

 ping." The term " Zipperlein " has been used in German for " Gicht " since 

 the fifteenth century. It was invented by sufferers from this disease in a sort 

 of grim humor. It is quite certain that the word " Gicht " is not, as was sup- 

 posed, in etymological relation with the English word " gout" or with words 

 of the same derivation in the Romanic languages (the French " goutte" the 

 Italian "gotta" the Spanish " gota"). These designations cannot be re- 

 jected, as they have become established by usage, but that they are not to be 

 looked upon as appropriate every one must admit. They are based upon the 

 old pathological conception that gout was caused by a peculiar humor distilled 

 from the blood, which, drop by drop, was exuded into the joints, a view for 

 the support of which no proof of any kind can be adduced. The designation 

 "Zipperlein" for gout has quite properly been excluded from scientific 

 nomenclature, as, in a symptomatologic connection, a uniform meaning is not 

 attached to it. Among the ancients, the pathologic term " gout " was em- 

 braced in the collective term " arthritis," under which every form of arthritic 

 inflammation was included. The term " arthritis " for " gout " embraces so 

 much more than the purely symptomatologic conception that it includes a 

 very important and active constituent of gout, namely, the " inflammation " 

 of a joint. The words podagra, chiragra, gonagra, omagra, ischiagra and 

 rachisagra, were applied by the ancients to joint pains in different regions of 

 the body, and pains chiefly due to gouty and rheumatic affections were thus 

 designated. 



Certainly to-day, when we speak of podagra, we mean only a gouty affec- 

 tion of the foot. The word " arthritis " of the ancients alone discloses noth- 

 ing as to the etiology of the joint inflammation. Later an attempt was made 

 to separate the various arthritic inflammations according to their cause, and 

 after we had demonstrated the causal relation of uric acid and its combina- 

 tion with alkalies to gout, the term arthritis urica, or uratica was given to 

 gouty joint inflammations. As, however, there are still differences of opin- 

 ion on this point, it would perhaps be wiser to speak only of gouty joint 

 inflammations, or, for one who is fond of foreign designations, of gouty 

 arthritis. 



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