. A text-book of medicine for students and practitioners . everal joints are simultaneoiisly invaded. Acute gouty inflamma-tions may appear in the tendon sheaths and in the fascia\ as well as in thejoints themselves, especially, for exam|)le, in the tendo Achillis, at the outeredge of the foot, etc. The longei- the disease has lasted, the less typical are the separate may now be less suffering at the time of an attack, but the articularchanges are more persistent. ^Ibe joints gradually become deformed. Thereare .symptoms referable to other |>arts of the body, and the gout grad
. A text-book of medicine for students and practitioners . everal joints are simultaneoiisly invaded. Acute gouty inflamma-tions may appear in the tendon sheaths and in the fascia\ as well as in thejoints themselves, especially, for exam|)le, in the tendo Achillis, at the outeredge of the foot, etc. The longei- the disease has lasted, the less typical are the separate may now be less suffering at the time of an attack, but the articularchanges are more persistent. ^Ibe joints gradually become deformed. Thereare .symptoms referable to other |>arts of the body, and the gout graduallypasses into its second chronic stage. Occasionally the disease is irregular and GOUT 123 aiypieal from its iiicipieiicy, and ihc lirst nuuiiltsl;iiioiis may not be arthritic,hut referahle to the kidneys (vide infra) or other organs. 2. Chronic Gout and the Gouty Diseases of Yaiuous Okgans.—Asa Ilde the most striking results of chronic gout are the clianges in the is a gradual development of marked deformity, particuhirly in the small. Fig. 111.—Acute attack of gout in the joints of the fingers. (Personal observation.) joints of the fingers, the joints of the great toe, and less often the other fingers (see Fig. 112) are deflected toward the ulnar side, at the meta-carpo-jihalangeal joints, as in arthritis deformans, and at the same time thelingers, as a whole, are thickened, particularly at the joints. Almost alwaysthe small finger joints early undergo tirm anchylosis. The great toes are oftenhcnt out of shape. Not infrequently tliere are formed around soiiu> of thejoints which are often attacked, particularly the metatarso-phalangeal joint oftlu! great toe, soft fluctuating masses, which arc very painful. If these l)urstsjjontaneously, or if they are incised, they are found to contain little, if any,pus, but much detritus, and nunurous crystals of uiic acid and urates (mainlythe monosodiuiii niates). Fig. 11.! sliows some of these ci-ystals
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