. The practice of medicine; a text-book for practitioners and students, with special reference to diagnosis and treatment . s totheir necessary relation holds, bj which we mean that identical conditionsoccur which are not due to gout, and the conclusion that they are thusrelated depends upon a definite knowledge of the previous existence of goutin the patient. An exception to this exists in the rare cases of actual GOUT 793 deposits of urates in certain situations, as the cornea, the crystaUine lens,vitreous humor, and even the retina. Of Chronic Gout.—As repeated attacks of gout occiu and the
. The practice of medicine; a text-book for practitioners and students, with special reference to diagnosis and treatment . s totheir necessary relation holds, bj which we mean that identical conditionsoccur which are not due to gout, and the conclusion that they are thusrelated depends upon a definite knowledge of the previous existence of goutin the patient. An exception to this exists in the rare cases of actual GOUT 793 deposits of urates in certain situations, as the cornea, the crystaUine lens,vitreous humor, and even the retina. Of Chronic Gout.—As repeated attacks of gout occiu and the patientgrows older, there gradually accumulate the morbid changes describedunder morbid anatomy as more or less characteristic—the joints deformedby tophaceous and ether deposits, the lipping, the seal-fin hand, the renaland arterio-vascular changes, interstitial nephritis, etc. The urine nowis increased, lighter hued, and contains albumin and a few hyaUne andgranular casts. Some further allusion should be made to the deformities thus resultingas symptoms of chronic gout. They appear especially in connection with. Fig. 131.—Tophaceous hands were symmetrically affected, man aged sixty—{after Duckworth). the toes and fingers, causing swellings, deflections, and torsions whichproduce the most fantastic shapes. Among these are deflected and ab-ducted toes. The seal-fin hand, and the deformities caused by tophaceousdeposits. It is important to remember that any of these except thetophaceous deposits may be due to rherunatoid arthritis as well as appended cut from Duckworth illustrates the appearance of enormoustophaceous deposits undoubtedly of gouty origin as contrasted withHeberdens nodosities. Diagnosis.—Only two events point unmistakably to gout in an in-dividual, viz., podagra or tophi in some portion of the body, ears, forearmsor joints. Gout prefers the distal, smaller joints, and one of these ratherthan many. Frequent recurrence in the same join
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