American practice of surgery : a complete system of the science and art of surgery . d up to the particular disturbance in metab-olism which is designated as gout. Such disturbances may be brought aboutin many ways. ;»:,(i AMERICAN PRACTICE OF SURGERY. Pathological Changes.—Like most of the metabolic diseases with joint mani-festations, gout develops its lesions slowly and insidiously, though exacerba-tions in individual joints arc not infrequently of relatively sudden onset. Theclassical location of goul in the joints is in the metacarpo-phalangeal articula-tions of the great toes, but this i
American practice of surgery : a complete system of the science and art of surgery . d up to the particular disturbance in metab-olism which is designated as gout. Such disturbances may be brought aboutin many ways. ;»:,(i AMERICAN PRACTICE OF SURGERY. Pathological Changes.—Like most of the metabolic diseases with joint mani-festations, gout develops its lesions slowly and insidiously, though exacerba-tions in individual joints arc not infrequently of relatively sudden onset. Theclassical location of goul in the joints is in the metacarpo-phalangeal articula-tions of the great toes, but this is only one of the more common situations. Thephalangeal articulations of the fingers and the metacarpo-phalangeal articula-tions of the hands arc very frequenl situations for evidences of gout. Thelarger joints ate less frequently concerned, hut the knees, ankles, wrists, andelbows are occasionally the seat of gouty deposits. Gouty tophi in the ears are very common, and. in cases where suspiciousgouty joints are found, the presence of tophi in the ears is valuable in confirma-. Fig. _M3.—Lateral View of the Foot Showing a Urate-of-Soda Deposit Ulcerating through t!over the Head of the fifth Metatarsal. Also shows destruction of the terminal phalanx of the great1 original. > tion of the diagnosis. Constitutional symptoms are associated with the moreactive stages of the disease. Such symptoms are headache, malaise, loss ofstrength, and loss of appetite. Associated with this and with the , redness, and tenderness in one or more of the joints, is an exeess of uricacid in the urine. Patients with gouty lesions will excrete a normal amount ofuric acid between attacks of gout, but immediately before and during an acutefbation an examination of the urine will show a great excess of uric acid,which subsides with the subsidence of the acute symptoms. Frequent exacer-bations of joint symptoms are very characteristic of the gouty diathesis. erential Diagnosis.—The di
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