150 GOUT 



the earliest ones, and the joint symptoms are secondary. Wten the latter de- 

 velop, the nephritic process is usually so far advanced that the gouty nature 

 of the affection can only be determined at autopsy, partly from the gouty 

 changes in the kidney, partly from the gouty changes in the individual joints, 

 particularly the first metatarsophalangeal joint. Fortunately this form of 

 gout is not very frequent. The diagnosis during life is only possible when the 

 conditions just described are recognized in the affected person. If the diag- 

 nosis of primary renal gout has been made, the prognosis is grave, as in all 

 severe interstitial renal inflammations, since the renal parenchyma is destroyed. 

 The therapy should be directed to the renal affection, for which diaphoresis 

 and the dietetic treatment mentioned in primary arthritic gout are first to 

 be tried. 



