Practice of medicine : a manual for students and practitioners . iagnosis: Usually there are dyspepsia and otherevidence of over-indulgence in rich food and alcohol, espe-cially the malt preparations, beer and ale. The polyarthritisusually, but not invariably, begins in the joint of the big inflammation remains fixed in the joints affected, which,together with the overlying tendons, become characteristicallydeformed through the deposit of urate of sodium in tophi(Fig. 37). Gout prefers the small joints. Males are mostfrequently affected. Examination of the urine shows theelimination of
Practice of medicine : a manual for students and practitioners . iagnosis: Usually there are dyspepsia and otherevidence of over-indulgence in rich food and alcohol, espe-cially the malt preparations, beer and ale. The polyarthritisusually, but not invariably, begins in the joint of the big inflammation remains fixed in the joints affected, which,together with the overlying tendons, become characteristicallydeformed through the deposit of urate of sodium in tophi(Fig. 37). Gout prefers the small joints. Males are mostfrequently affected. Examination of the urine shows theelimination of little or no uric acid during the paroxysm :during the interval the excretion of uric acid is greatly in-creased as a rule. Sometimes gout finds expression in con- OOUT. 351 junctivitis, iritis, corneal ulcer; or the deposit of tophi inthe ear, nose, eyelids, and larynx. Gout should be differentiated from rheumatism, especiallyfrom arthritis deformans, in which the disease usually beginsin the hands and more fre- quentlyjoints. involvesThere the largerusually. little or no fever in gout Prognosis: Good in acutegout. Chronic gout maytake life through disease ofthe kidneys, heart, or brain. Gout — treatment: Mostimportant is the regulationof the life of the individual,especially as to diet and ex-ercise. The use of artificialalkaline mineral water, orbetter a sojourn at thesprings, may sometimes suf-fice even without the use ofdrugs. The waters usuallyrecommended are Vichy,Carlsbad, and the lithiatedwaters. The most popularsprings are those of Carls-bad, Homberg, Wildbad, inGermany ; Contrexevilleand Aix-les-Bains, France;Bath and Buxton, in Eng-land ; and Saratoga, Bed-ford, and the White Sulphur Springs in this country. In the way of drugs, most may be accomplished with thewine of eolchioum, piperazin, and the salicylates. The limbshould be wrapped in cotton-wool. The local application ofhot air may be tried. The bowels should be kept open. Cal-omel is often of value early i
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Keywords: ., boo, bookcentury1800, bookdecade1890, booksubjectclinicalmedicine
