126 GOUT 



The name gout has the advantage that it indicates nothing more than the 

 pain which always plays a prominent role in gouty affections. 



It must be remembered, however, that in gout we are not dealing with pain 

 that is restricted to the joints, but with a general pain which is well described 

 by Trousseau, " totum corpus est podagra." We shall refer to this more 

 minutely when we consider the clinical aspect of gout. 



Gout is certainly a disease of antiquity. It is not my intention here to 

 discuss in detail the historical aspect of the disease. A. Delpeeh has recently 

 written quite a voluminous work (678 pages) on the history of gout and of 

 rheumatism, in which he dwells upon the antiquity of the disease, and brings 

 it down to the time of Thomas Sydenham (1624-1689). In the study of the 

 clinical history of gout, we, as a rule, only go back to the time of Sydenham, 

 and, it appears to me, quite properly so. Sydenham's description is an account 

 of his own illness, for, when he wrote his dissertation, he had already been 

 suffering from gout for thirty-four years. All that had been written prior to 

 Sydenham's time regarding the symptomatology of gout was of little value 

 compared with what Sydenham communicated to us. The elucidation of the 

 cause and the cure of gout Sydenham bequeathed to posterity. 



THE PATHOGENESIS OF GOUT 



The pathogenesis of gout has been studied from many points, and is now 

 by preference our subject of investigation. It was the theme which occupied 

 the attention of the Section on Internal Medicine of the Xlllth Medical Con- 

 gress in Paris. I was unable to perform the task allotted to me, and give a 

 synopsis of this subject at the Congress; but, at Easter-tide, 1900, I sent to 

 the Secretary of the Section of Internal Medicine a compilation setting forth 

 my views, and it may not now be out of place briefly to discuss the present 

 standing of the question as set forth in this thesis. The views expressed by 

 me were as follows : 



1. Gout is a more or less chronic disease which develops upon the basis 

 of a pathologic predisposition which is hereditary and generally congenital, 

 and is usually designated the uric acid diathesis. 



2. Eegarding the ultimate cause of the uric acid diathesis, merely 

 hypotheses can be at this time proposed. The intimate relations existing 

 between the nucleins and uric acid make it appear likely that in the uric acid 

 diathesis there is an abnormal composition of the cell nucleus; that is, of the 

 protoplasm in the person in question. It is quite evident that an individual 

 predisposition which may assert itself through entire families and races is a 

 prominent factor in the uric acid diathesis. 



3. Various circumstances appear to show that true gout develops from 

 the uric acid diathesis. Eegarding these circumstances the following may be 

 mentioned : 



(a) The more pronounced the uric acid diathesis in a person, the earlier, 

 that is, the more decidedly, ceteris paribus, will gout develop in him. 



(h) There are habits which favor the appearance of gout; among these 

 are indolence and high living, especially the combination of these,, and, of 



