Gout

About this eBook

Author

Llewellyn, Llewellyn J. (Llewellyn Jones), 1870?-1934

Title

Gout, with a section on ocular disease in the gouty

Original Publication

United States: C. V. Mosby Company,1921.

Credits

Mark C. Orton and the Online Distributed Proofreading Team at www.pgdp.net (This file was produced from images generously made available by The Internet Archive)

Language

English

LoC Class

RC: Medicine: Internal medicine

Subject

Eye -- Diseases

Category

Text

Project Gutenberg

eBook-No. 69874

Release Date

January 24, 2023

Copyright

Public domain in the USA.

Contents

1. 1.GOUT
2. 2.PREFACE
3. 3.TABLE OF CONTENTS
4. 4.CHAPTER I HISTORICAL AND INTRODUCTORY — The Antiquity of Gout — Prevalence of Gout in the Anglo-Saxon Period — Views of the Humoralists — The Aphorisms of Hippocrates — Introduction of the Word “Gout” — Early Views as to the Nature of Tophi — The “Honour of the Gout” — That Gout confers Immunity from other Disorders — Growing Infrequency and Attenuation of Gout
5. 5.CHAPTER II THE PEDIGREE OF GOUT — Isolation of Acute Articular Rheumatism From Gout — Tardy Dissociation of Chronic Gout From Chronic Rheumatism — Identification of Muscular Rheumatism — Differentiation of Chronic Gout From Arthritis Deformans — Cleavage of Arthritis Deformans into Two Types — Elimination of the Infective Arthritides
6. 6.CHAPTER III EARLIER THEORIES OF PATHOGENESIS — Garrod’s Theory — Antagonistic Views — Histogenous Theories — Antecedent Structural Changes — Hepatic Inadequacy — Hyperpyræmia — Nervous Theories — Growing Scepticism as to Garrod’s Pathogeny of Gout
7. 7.CHAPTER IV DEFINITION, CLASSIFICATION, ETIOLOGY, AND MORBID ANATOMY — Definition and Classification — Classification — Suggested Classification of Articular Gout — Etiology and Morbid Anatomy — Summary — Morbid Anatomy
8. 8.CHAPTER V PATHOLOGY OF GOUT—PROTEIN METABOLISM — Revelations of the Bio-Chemist — Protein Metabolism — The Formation of Urea — Fate of the Amino-Acids — Seat of Formation of Urea — Amino-Acids in Relation to Gout — The Glycocoll Theory of Gout — Urea Excretion in Gout — Creatine and Creatinine — Inborn Errors of Metabolism
9. 9.CHAPTER VI NUCLEIN METABOLISM — The Isolation of Nucleic Acid — Researches on Spermatozoa — The Discovery of Purins — Uric Acid a Derivative of Nucleic Acid — The Chemistry of Uric Acid and the Purin Bodies — Chemical Constitution — Structural Formulæ — Properties of Uric Acid — Uric Acid in the Blood — Gudzent and Schade’s Theories — Organic Combinations — Complexity of the Problem
10. 10.CHAPTER VII SOURCES OF URIC ACID — Exogenous Purins — Exogenous Uric Acid Excretion — Fate of the Unexcreted Purin — Endogenous Purins — Source of Endogenous Purins — Proteins and their Derivatives — Amino-Acids and Dicarboxylic Amino-Acids — Endogenous Uric Acid Excretion — Factors Influencing Endogenous Uric Acid Excretion — Physiological Conditions — Pathological States — Synthetic Formation of Uric Acid
11. 11.CHAPTER VIII FORMATION AND DESTRUCTION OF URIC ACID — Distribution of the Enzymes — Stages in Disruption of Nucleic Acid — Destruction of Uric Acid
12. 12.CHAPTER IX URIC ACID IN RELATION TO GOUT — Uric Acid Excretion in Gout — Uric Acid Variations in Acute Gout — Uric Acid Variations in Chronic Gout — Retarded Exogenous Uric Acid Output — Lowered Endogenous Uric Acid Output — Other Anomalies in Excretion in Gout — Purin Metabolism in other Disorders — Purin Metabolism in Chronic Alcoholism and Plumbism — Infantile Gout
13. 13.CHAPTER X THE RENAL THEORY OF GOUT — Anomalies in Uric Acid Excretion in Gout — Uricæmia in Nephritis — Uric Acid, Urea N, and Creatinine of Blood in Gout and Early and Late Nephritis — The Relationship, if any, between the Amounts of Uric Acid and of Urea, and Total Non-Protein Nitrogen in Human Blood — Uricæmia not Necessarily Due To Renal Defect — Uricæmia not Peculiar to Nephritis — Uricæmia does not Necessarily Portend Gout — To what may be Ascribed the Deficient Eliminating Capacity of the Kidney for Uric Acid? — Uratic Deposits in Nephritis — Differentiation of Uratic Deposits in Gout and Nephritis — Clinical Associations of Gout and Granular Kidney
14. 14.CHAPTER XI URICÆMIA IN GOUT — Folin and Denis’s Method — Uric Acid a Normal Constituent of Blood — Uric Acid, Total Non-Protein Nitrogen and Urea Nitrogen in Blood — Uric Acid, Total Non-Protein Nitrogen and Urea Nitrogen in Blood — Effect of Exogenous Purines — Uric Acid Content of Blood in Gout — Hyper-Uricæmia in Non-Gouty Arthritis — Variations in Uric Acid Content of Blood Independently of Diet — What Relation, if any, Exists between the Uric Acid Content of the Blood and Attacks of Gout? — Discussion of the Foregoing Data
15. 15.CHAPTER XII URATOSIS IN RELATION TO GOUT — Constitution of Tophi — Marchand’s Analysis — Lehmann’s Analysis — Ebstein and Sprague’s Analysis — Mode of Formation — Localisation of Uratic Deposits — The Causation of Tophi — Solubilities of Uric Acid — Tophi in Relation To Uricæmia — Tissue Affinities for Uric Acid — Retention Capacity of Tissues for Uric Acid — Table I.—Concentration of Uric Acid in Human Tissues and Fluids per 100 Grams of Material — Table II.—Concentration of Uric Acid in Miscellaneous Human Tissues per 100 Grams of Material — Clinical Evolution of Tophi — The Cause of the Inflammatory Phenomena — Non-Toxicity of Uric Acid — Are the Precursors of Uric Acid Toxic?
16. 16.CHAPTER XIII THE RISE OF THE INFECTIVE THEORY — Suggestion of a Specific Infection
17. 17.CHAPTER XIV GOUT AS AN INFECTION — Local Foci of Infection — Summary
18. 18.CHAPTER XV GOUT AS AN INFECTION ( continued ) — Analysis of the Acute Paroxysm — The Evolution and Life History of Gout — Analogies between Gout and the Specific Infective Arthritides — Correlation of the Metabolic Phenomena of Gout with the Postulated Infective Element
19. 19.CHAPTER XVI CLINICAL ACCOUNT — Acute Localised Gout — Prodromal Symptoms — The Acute Paroxysm — Detailed Consideration of Phenomena
20. 20.CHAPTER XVII CLINICAL ACCOUNT ( continued ) — Acute Generalised Gout — Collateral Phenomena of Gout — Incidence of Gouty Stigmata in Various Types of Fibrositis
21. 21.CHAPTER XVIII CLINICAL ACCOUNT ( continued ) — Chronic Articular Gout — The Joint Deformities of Chronic Gout — Tophi: Their Evolution and Distribution — Other Sites of Tophi — Affinities Between Gout and Other Diseases — Gout in Relation to Glycosuria — Gout in Relation to Phlebitis — Cutaneous Disorders — Gout and Nephritis — Prognosis in Gout
22. 22.CHAPTER XIX ETIOLOGICAL AND CLINICAL DIAGNOSIS — Articular Gout — Etiological Diagnosis — Clinical Diagnosis — Introductory Remarks — The Diagnostic Status of Tophi — Tophi in Relation to Arthritis — Frequency of Tophi in True Gouty Arthritis Underestimated — Difficulty of detecting Tophi
23. 23.CHAPTER XX CLINICAL DIAGNOSIS ( continued ) — Acute Articular Gout—Localised Variety — Differential Diagnosis — Gout in the Big Toe — Static Foot Deformities — Gout in the Instep — Gout in the Heel — Local Sources of Fallacy — Gout in the Sole — Anomalous Sites for Initial Outbreaks
24. 24.CHAPTER XXI CLINICAL DIAGNOSIS ( continued ) — Acute Gouty Polyarthritis — Differential Diagnosis — Acute Articular Rheumatism — Acute Gonococcal Arthritis — Secondary Syphilitic Arthritis — Acute Rheumatoid or Atrophic Arthritis — Infective Arthritis of Undifferentiated Type
25. 25.CHAPTER XXII CLINICAL DIAGNOSIS ( continued ) — Chronic Articular Gout — Chronic Monarticular Gout — Monarticular Gout in Large Articulation a Rarity — Chronic Gout of Oligo-articular Distribution — Its Confusion with Chronic Villous Synovitis — Villous Synovitis Static and Non-gouty in Origin — Clinical Symptoms of Villous Synovitis — Chronic Gout of Polyarticular Distribution — Differential Diagnosis — Osteoarthritis — Local Characters of Joint Swellings — Rheumatoid Arthritis — Local Characters of Joint Swellings — Nerve Arthropathies — Hæmophilic Arthritis
26. 26.CHAPTER XXIII CLINICAL DIAGNOSIS ( continued ) — Skiagraphy — Differential Diagnosis
27. 27.CHAPTER XXIV IRREGULAR GOUT — Retrocedent Gout — Other Irregular Manifestations — Infantile Gout
28. 28.CHAPTER XXV OCULAR DISEASE IN THE GOUTY — Iritis .
29. 29.CHAPTER XXVI TREATMENT OF GOUT — Radical Treatment of Local Foci of Infection or Toxic Absorption — Diet
30. 30.CHAPTER XXVII TREATMENT OF GOUT ( continued ) — Regulation of Diet in the Gouty — The Individual Foodstuffs — Special Dietaries — Beverages in Gout — Alcohol in Gout — The Various Alcoholic Beverages
31. 31.CHAPTER XXVIII MEDICINAL AND OTHER MODES OF THERAPY—ACUTE GOUT — Medicinal Therapy — Acute Gout — Colchicum in Acute Gout. — Local Measures in Acute Gout.
32. 32.CHAPTER XXIX MEDICINAL AND OTHER MODES OF THERAPY ( continued )—INTER-PAROXYSMAL PERIOD — Treatment in the Inter-paroxysmal Period
33. 33.CHAPTER XXX MEDICINAL AND OTHER MODES OF THERAPY ( continued )—CHRONIC ARTICULAR GOUT AND ASSOCIATED MORBID CONDITIONS — Chronic Articular Gout — Local Measures in Chronic Articular Gout — Treatment of Associated Morbid Conditions
34. 34.CHAPTER XXXI. CLIMATO-THERAPY, HYDRO-THERAPY, ETC — Climate and Residence — Exercise — General Massage — General Hydro-therapy — Methods of Application of General Hydro-therapy — Methods of Local Hydro-therapy — Treatment by Hyperæmia
35. 35.CHAPTER XXXII MINERAL SPRINGS AND CHOICE OF SPA — Mineral Springs — Radio-active Waters — Influence on Uric Acid Metabolism — Therapeutic Action and Application — Choice of Spa — Associated Morbid Conditions — Concluding Remarks on Spa Treatment — Spas from a National Aspect
36. 36.FOOTNOTES
37. 37.INDEX

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