130 GOUT 



cannot be doubted that the abuse of alcohol during his student days as well 

 as the previously mentioned obesity, conduced to the development of the gouty 

 paroxysms. But it must be emphasized that, in my patient, the later disap- 

 pearance of his corpulence did not lead to the cessation of the gout. Obesity 

 is, therefore, not a prerequisite for the production of gout, although they 

 may occasionally occur in combination, sometimes with diabetes mellitus as 

 well. Of further interest in my patient's history is the fact, that in proportion 

 as he deviated from the mode of life advised by me, the latent gout, i. e., the 

 gouty diathesis, asserted itself by the appearance of repeated paroxysms, and 

 that the last attack of this kind occurred after a fall from a bicycle whereby 

 he sustained a contusion of the left knee-joint and of the right talocrural. 

 I do not consider this occurrence of a gouty paroxysm after trauma as by any 

 means accidental. Opposed to its beiag a mere coincidence is the frequency with 

 which this combination appears. My patient is a physician in easy circum- 

 stances. We know that the wealthy minority, the so-called " upper ten thou- 

 sand," are most frequently the subjects of gout. Among our hospital patients 

 who, for the most part, belong to the poorer classes of the population, gout 

 has heretofore been looked upon as a rare affection. I saw a poor tailor in the 

 Hospital of the Home for Incurables in Breslau, who showed extensive, partly 

 ruptured gouty tophi. Yet when I review the cases of gout accumulated dur- 

 ing my long professional service in the Hospital, the number of the poor is 

 quite small when compared with those in better circumstances whom I have 

 seen in consultation and in my private hospital. In this connection, there 

 has lately been a remarkable change in Germany, and one which is food for 

 thought. Albert Praenkel, in the Eeport of the Medical Division of the 

 Hospital Urban in Berlin, from the year 1896 to 1897, and among 1,706 male 

 patients, has observed 24 cases of arthritis uratica. In the hospitals of Eng- 

 land, previous to this, the number of gouty patients was a striking one. In 

 the years 1874 to 1876, in the Medical Division of St. George's Hospital in 

 London, among 4,695 patients, not less than 97 cases of gout were present, 

 while, in the same period of time, in the Munich Medical Clinic, among 4,670 

 patients, there were only 11 cases of gout. We might say, it is true, that in. 

 this coincidence plays a leading role. But it must be observed that in the 

 same period of time, and in nearly the same number of patients, in a London 

 Hospital, there were almost nine times as many cases of gout as in the Munich 

 Hospital. If it is true that in Munich, upon the average, more than 300 liters 

 of beer per capita of the population are yearly consumed, the conclusion must 

 be drawn that the influence attributed to Munich beer in the development of 

 uric acid gout must be regarded as erroneous during the period just men- 

 tioned. The reports of His, Jr., and Magnus-Levy favor the increase of gout 

 among the poorer population of Germany. Among the poor people of Leipsic 

 the former not infrequently saw gout. The latter, in the Out-Patient Medical 

 Clinic in Strassburg, made the same observation. ISTevertheless, the social posi- 

 tion, that is, the wealth or poverty of the individual— hence his mode of life- 

 has no fundamental influence upon the development of gout. The special 

 disposition of the person which is noted in other members of the same family, 

 even in entire races, and which may be hereditary, is the important point. It 



