Chapter XXXII: Mineral Springs and Choice of Spa (3)

=Blood=, human, relationship between amounts of uric acid, urea and
non-protein nitrogen in, 122
in chronic interstitial nephritis, urates in, 120
in disease, uric acid of, 137
portal, amino-acids in, 62
routine examination of, in diagnosis of articular gout, 249
uric acid as normal constituent of, 135
uric acid content of, and gout, relation between, 143
effect of diet upon, 141
effect of exogenous purins on, 137
estimation of sources of fallacy, 145
in gout, 133, 139
uric acid in, 24, 34, 78
discovery of, 21
Folin and Denis’s method of determination, 133
forms of, 145
Gudzent and Schade’s theories, 79
non-protein nitrogen and urea nitrogen in (table), 136
variations in uric acid content independently of diet, 142

=Bodily= conformation, and gout, 44

=Boils=, gout following, 53, 178

=Bone=, conditions of, revealed by skiagraphy, in diagnosis of gout,
286

=Bones=, changes in, in gout, 53
focal areas of rarefaction in, revealed by skiagraphy, 286, 287

=Brandy= in gout, 371

=Bruce’s= modes, 286

=Bunion=, inflamed, differential diagnosis from gout, 261

=Burian= and Schur’s researches on sources of uric acid, 83

=Bursæ=, involved in gout, 195
tophi in, 233

=Bursitis=, olecranon, gouty, 215
post-calcaneal, in referred pain in heel, 265

=Cælius Aurelianus’s= views on gout, 5

=Caffeine=, 85

=Calcium= carbonate in inter-paroxysmal periods of gout, 392
salts in gouty tophi, 151

=Calculus=, urinary, 29

=Carbohydrates= in diet of gouty, 347

=Carbuncles=, gout following, 53, 178

=Cartilage=, morbid changes in, 53
uratic deposits in, 52, 153
in nephritis, 128

=Cataphoresis= in treatment of chronic articular gout, 407

=Cell= protoplasm, chemistry of, 176

=Celsus’s= views on gout, 4

“=Chalk-stones=,” 150

=Chalybeate= waters, spas for, 442

=Champagne= in gout, 368

=Charcot’s= discovery of nerve arthropathies, 18
joint, differential diagnosis from chronic articular gout, 277

=Chemistry= of uric acid and purin bodies, 75

=Chilblains= confused with early stages of tophi formation, 164

=Chirargra=, Greek designation, 3

=Cholecystitis=, 184

=Cider= as beverage in gout, 363

=Claret= in gout, 369

=Climate= and gout, 45
and residence in treatment of gout, 418

=Climato-therapy= in gout, 418

=Clothing=, importance of, 421

=Cocoa= as beverage in gout, 361

=Coffee= as beverage in gout, 361

=Colchicine= in treatment of acute gout, 378

=Colchicum= in acute gout, 192, 374, 375, 378
contra-indicated, alkalies as substitute, 383
method of administration, 376
preparations and dosage of, 376
used by Aetius, 6

=Colitis=, mucous, initial manifestations of gout, 175

=Colloids= in gouty tophi, 152

=Collosol= iodine in treatment of chronic gout, 402

=Colorimetric= method of determining uric acid in blood, 133

=Colour= reaction test in blood analysis, 133

=Condiments= in diet of gouty, 350

=Constipation=, effect in gout, 337
in acute gout, treatment of, 373
in chronic gout, treatment of, 400
in inter-paroxysmal periods of gout, treatment of, 393

=Constitutional= disturbance in gout, 188
influences in formation of tophi, 161

=Corpora= cavernosa of penis, tophi in, 235

=Cramps= in acute gout, 210

=Cream=, effect of, on uric acid output, 348

=Creatine=, 63, 67
in urine of children, 68

=Creatinine=, 61, 63, 67, 68
in blood in gout and nephritis (table), 121

=Crystalline= deposits in synovial fluid, 54

=Crystalloids= in gouty tophi, 152

=Cytosine=, 98

=Cullen’s= differentiation of varieties of rheumatism, 16
theory of ætiology of gout, 21

=Cutaneous= disorders in gout, 240
gravel, 203

=Cuticule=, desquamation of, typical of gout, 191

=Cystin= in urine, 59

=Cystinuria=, 69

=Cystoid= degeneration in gout, 56

=Deaminisation= of amino-acids, 62, 63

=Deficiency= diseases and accessory food factors, 340

=Degeneration=, theories of, 25, 27

=Desquamation= in acute gout, 212

=Diabetes=, glycosuria and, 60

=Dicarboxylic= amino-acids, 89

=Diet=, effect of, on blood content of uric acid, 141

=Diet= on excretion of uric acid, 83

=Diet= in acute paroxysms of gout, 332
in albuminuria, 358
in amylaceous dyspepsia, 351, 352
in chronic gout, 334
in glycosuria, 357
in hyperchlorhydria, 353
in hyperuricæmia, 354
in hypochlorhydria, 354
in inter-paroxysmal periods of gout, 391
in reduction of obesity, 357
in treatment of gout, 332
“accessory food factors,” 339
carbohydrates, 347
collaboration of clinician and bio-chemist, need for, 337
condiments, 350
fats, 347
fish, 346
fruits, 349
idiosyncrasies of, 343
physical examination necessary before, 336
proteins, 345
regulations of, 342
vegetables, 348
variations of blood content of uric acid independently of, 142

=Dietaries=, fixed, fallacy of, in treatment of gout, 335

=Digestion=, disturbances of, prevention of, in treatment of gout,
335

=Digestive= glands, _rôle_ of, in uric acid excretion, 88

=Diocletian=, edict by, _re_ gout, 5

=Dislocations=, signalising attack of gout, 53

=Douches=, 428

=Dover’s= powder, with aspirin and phenacetin, in treatment of acute
gout, 383

=Drink= and gout, 48

“=Drug= dyspepsia,” 391

=Drugs= influencing excretion of endogenous uric acid, 96

=Duckworth’s= classification of arthritic type of gout, 36
theory of ætiology of gout, 33

=Dyschezia= and gout, 337

=Dysenteric= arthritis, differential diagnosis from acute gouty
polyarthritis, 272

=Dysentery=, complicated by arthritis and myalgias, 194

=Dyspepsia=, amylaceous, diet in, 351, 352
atonic, muriated waters in treatment of, 444
chronic, gout associated with, 178
“drug,” 391
gouty, no specific form of, 350
intestinal, preceding gout, 182
mineral waters in treatment of, 443
spas in treatment of, 442

=Dyspeptic= symptoms of acute localised gout, 201

=Ear=, pricking or tenderness in, 203
tophus in, 202

=Ears=, tophi in, antedating articular outbreaks, 203

=Ebstein= and Sprague’s analysis of tophi, 150

=Ebstein’s= theory of ætiology of gout, 25

=Ecchymoses=, local, in acute gout, 212

=Eczema=, gouty, spa treatment of, 451
treatment of, 416
in gout, 241

=Egypt=, osteoarthritis in, in ancient times, 1

=Endemic= areas of gout, 46

=Endogenous= purins, 87
origin of, 83
source of, 88
uric acid excretion, 91
factors influencing, 93
increased by purin-free proteid food, 89
pathological states influencing, 94
periodic variations of, 94
physiological conditions, 93

=Environment= in gout, 40

=Enzymes=, distribution of, 99
in intestinal juices and wall, 100

=Epistaxis=, gout following, 178

=Epithelial= cells, nucleus in gouty tophi, 151

=Erysipelas=, gouty arthritis simulating, 215

=Erythromelalgia=, differential diagnosis from gout, 266

=Etiological= diagnosis of articular gout, 247

=Exercise= in gout, importance of, 421
relation of, to gout, 337

=Exogenous= origin of purins, 83
purins as source of uric acid, 84
uric acid excretion, 85

=Exudative= diathesis, 116

=Eye=, deposition of urates in, 309
gout in, evidence of, 309
gouty diathesis in regard to, 310

=Eyelids=, uratic deposits in, 235

=Fæces=, examination of, in diagnosis of articular gout, 250
in treatment of gout, 337

=Fasciæ=, involved in gout, 195

“=Fat= soluble A,” 340

=Fats= in diet of gouty, 347

=Feet=, incidence of tophi in, 162
plantar surface of, tophi in, 235

=Fibrosis=, interstitial, chronic, 186
of visceral organs in gout, tendency to, 186

=Fibrositis= associated with acute articular gout, 195
associated with gout, treatment of, 411
gouty, acute brachial, treatment of, 412
incidence of gouty stigmata in types of, 221, 222
muscular, in gouty, massage in, 423
spa treatment of, 450

=Fingers=, deformed, in chronic gout, 230
pulps of, tophi in, 235

=Fischer’s= researches on protein molecule, 61

=Fish= in diet of gouty, 346

=Flatfoot=, pains in, differential diagnosis from gout, 263

“=Flying= gout,” 193

=Foci= of infection in gouty, 53
local, in gout, 177

=Foci=, relation to gouty synovitis and arthritis, 185

=Folin= and Denis’s method of determination of uric acid in blood,
133
researches into urea formation, 63

=Food=, cooking of, in diet of gouty, 344
influence on gout, 48

=Foods=, various, exogenous urinary purin in, amount of, 85

=Foot= deformities, static, differential diagnosis from gout, 261

“=Fot-adl=,” Anglo-Saxon name for gout, 3

=Fractures=, signalising attack of gout, 53

=Fruits= in diet of gouty, 349

=Function=, gout a disorder of, 200

=Functional= disturbances in gout, 201

=Galen’s= views on gout, 2, 4

=Gall-stones=, gout associated with, 184

=Gall-bladder dyspepsia=, 184

=Garrod’s= discovery of uric acid in blood of gouty persons, 21
pathogeny of gout, growing scepticism as to, 32
theory of ætiology of gout, 22
views on gout in the eye, 320

=Gastralgias= in gouty, 351

=Gastric= catarrh, chronic, gout associated with, 351
chronic, mineral waters suitable for, 445
glands, diseased conditions of, and gout, 173
insufficiency, muriated waters in treatment of, 444

=Gastro-intestinal= asepsis, importance of, in gout, 332
derangements in acute paroxysms of gout, 333
disorders and gout, 180
attributed to gout, 299-302
chronic, spas in treatment of, 442
mineral waters in treatment of, 443
tract, derangement of, cause of gout, 170

=Genito-urinary= passages, infection of, examination for, in
diagnosis of articular gout, 249
tract, examination of, in treatment of gout, 331

=Geographical= distribution of gout, 45-48

=Gin= in gout, 371

=Glandular= affections in gouty subjects, 179

=Glaucoma=, gout and, 324

=Glycocine= and urea, interaction between, 84

=Glycocoll=, _rôle_ of, 64
theory of gout, 65
uric acid excretion augmented by, 89

=Glycosuria= and diabetes, 60
associated with gout, treatment of, 414
diet in, 357
examination for, in treatment of gout, 337
gout and, co-existence of, 185
gout in relation to, 236
“gouty,” 182
spa treatment of, 449

=Glyoxylic= acid in gouty urine, 65

=Gonococcal= arthritis of tarsus and metatarsus, differential
diagnosis from gout, 263
infection, articular involvement, with muscular and nervous
lesions, 194
differential diagnosis from gout, 259
exclusion of, in diagnosis of articular gout, 248

=Gore=, Ringrose, theory of pathology of gout, 173

=Gout=, acute, colchicum in, 375
definitely paroxysmal, 191
general phenomena of, 210
ionisation in treatment of, 387
local phenomena, 211
localised, clinical account, 200
dyspeptic symptoms of, 201
premonitory articular pains, 204
prodromal symptoms, 200
locality of, 208
medicinal treatment of, 372
onset of, 207
pain in, 208
paroxysm of, analysis of, 188
diet in, 332
symptoms of, 205
uric acid variations in, 117
surgical methods considered, 388
treatment of, alternative remedies in, 381
local measures, 384
uric acid excretion in, 117, 211
uric acid variations in, 108, 117
ætiology of, histogenous theories of, 23
nervous theories, 31
summary of, 44
theory of antecedent structural changes, 25
age factor in, 40
alcohol in, 361
amino-acids in relation to, 64
and fibrositis, incidence of, 221
and granular kidney, clinical associations of, 130
and immunity, early fallacies regarding, 10
and nephritis, 242
and other diseases, affinities between, 236
and rheumatoid arthritis, resemblance between, 113
and specific infective arthritides, analogies between, 194
antiquity of, 1
arterio-sclerosis associated with, 245
articular, acute, differential diagnosis, 259
localised, clinical diagnosis, 258
chronic, 225
alkalies in treatment of, 399
blood changes in, 226
clinical diagnosis of, 275
distribution of, 226
local measures in, 407
medicinal and other modes of therapy, 397
progress of disease, 228
surgical treatment, 409
classification of, author’s division, 38
clinical diagnosis of, 252
etiological diagnosis, 247
manifestations of, 195
as an infection, 177
auto-intoxication theory, summary, 182
beverages in, 359
blood content in, 127
uric acid and, relation between, 143
choice of spa in treatment of, 440
chronic, ankylosis in, 287
confusion with chronic villous synovitis, 279
diet in, 334
differentiation of, from arthritis deformans, 16
joint deformities of, 229
of oligo-articular distribution, 278
polyarticular, clinical features, 282
polyarticular, differential diagnosis, 282
tardy dissociation of, from chronic rheumatism, 15
uric acid variations in, 109
classification of, 35, 36
climate and residence in treatment of, 418
climato-therapy in, 418
clinical account of, 200
clothing and, 421
collateral phenomena of, 219
constipation and, 337
cutaneous disorders in, 240
definition of, 35
author’s, 36
derangement of gastro-intestinal tract as cause of, 171
elimination of infective arthritides from domain of, 19
endemic areas in, 46
etiology of, 39
evolution and life history of, 193
excretion in, anomalies of, 112
exercise in, importance of, 421
false, ocular symptoms, 322
glycocoll theory of, 65
Greek physicians’ views of pathology of, 3
growing infrequency and attenuation of, 12
guanine, in swine, 100
heredity and, 41
hydrotherapy, general, in treatment of, 424
local, in treatment of, methods of, 428
hyperpyræmia in ætiology of, 30
in big toe, differential diagnosis, 259
infantile, 116, 305
infective theory of, rise of, 171
summary, 182, 183
inflammatory phenomena in, cause of, 165
initial attacks usually monarticular, 207
initial outbreaks of, anomalous sites for, 267
sites of, 37
in relation to glycosuria, 236
in relation to phlebitis, 239
in the heel, 264
in the instep, 262
in the sole, 265
inter-paroxysmal period, treatment in, prophylactic measures, 389
introduction of word, 6
irregular, 293
conclusions regarding, 304
isolation of acute articular rheumatism from, 15
lead workers predisposed to, 50
leanness in, 337
leucocytosis in, 172, 189
life history of, 193
local foci of infection, 177
treatment of, radical, 327
local syncopes and asphyxias of hands in, 45
long-continued, favouring onset of pre-senilism, 398
lumbago associated with, 221
massage, general, in treatment, 423
metabolic phenomena correlated with postulated infective element,
195
mineral springs in treatment of, 431
monarticular, chronic, differential diagnosis of, 276, 277
morbid anatomy of, 39, 53
morbid conditions associated with, treatment of, 411
obesity in, reduction of, 356
ocular disease in, 308
frequency a factor in diagnosis, 316
onset of, symptoms, 188
organic predisposition to, 43
other conditions classified as, in early times, 12
pathogenesis of, earlier theories of, 21
pedigree of, 14
periodicity of, 191
phenomena of, detailed account of, 207
predisposing causes of, summary of, 52
prevalence of, in Anglo-Saxon period, 2
prognosis in, 244
renal theory of, 117
restriction of, by elimination of other disorders, 19
retarded purin elimination in, 118
retention capacity of tissues for uric acid in, 158
retrocedent, 39, 296
irregular manifestations of, 299
sex incidence of, 41
skiagraphy in diagnosis of, 286
specific organism suggested, 175
sthenic, febrile stage of, alcohol and, 333
structural changes, 54
sub-infection theory, summary, 182, 183
subjective phenomena of, in relation to blood content and
excretion
of uric acid, radium emanations and, 438
“the honour of,” 8
theory of hepatic inadequacy, 28
tophaceous, 39
treatment of, 327
diet in, 332, 342
fallacy of fixed dietaries, 335
gastro-intestinal asepsis in, 332
hyperæmia, 429
physical examination necessary before dieting, 336
prevention of digestive disturbances, 335
uratic deposits in, 54
differentiation from nephritis, 129
localisation of, 153
uratosis in relation to, 149
urea excretion in, 66
uric acid content of blood in, 139
uric acid excretion in, 108
anomalies in, 117
uric acid in relation to, 107
uric acid theory of, 21
uric acid, urea and creatine in blood in (table), 211
uricæmia in, 125, 133
not cause, but result, of, 148
variations in excretion in, diagnosis of, 60

=Gouty= arthritis, definition of, 20
phlebitis, 240
polyarthritis, acute, 214
stigmata in types of fibrositis, 222

“=Gravel=, cutaneous,” 203
immunity from, 29

=Greek= physicians, terms used for forms of gout, 3
views of pathology of gout, 3

=Guaiacum= in treatment of chronic gout, 403
resin, effects on urine, 405

=Guanase=, 100, 101

=Guanine=, 73, 75, 77, 98
gout in swine, 100

=Gudzent= and Schade’s theories of uric acid in blood, 79

=Gummata=, peri-bursal, 281
peri-synovial, 281

=Gums=, recession of, early, 45

=Hæmatemesis=, gout following, 178

=Hæmo-analysis=, 147

=Hæmophilic= arthritis, differential diagnosis from chronic gout,
285

=Hæmorrhage=, retinal, and gout, 322

=Hair=, premature whitening of, 45

=Hallux= rigidus, differential diagnosis from gout, 262
valgus with inflamed bunion, differential diagnosis from gout, 261

=Haly Abbas’s= views on gout, 6

=Hand=, gouty polyarthritis in, 214

=Hands=, deformed, in chronic gout, 230
incidence of tophi in, 162
local syncopes and asphyxias in gout, 45
palms of, tophi in, 235

=Hare’s= theory of ætiology of gout, 30

=Heart= affections in gouty subjects, 302

=Heberden’s= differentiation of rheumatoid arthritis from gout, 17
nodes, 41, 283

=Heel=, gout in, 264
referred pain in, differential diagnosis in, 264
local sources of fallacy, 265

=Hepatic= derangement in acute paroxysms of gout, 333
inadequacy theory of ætiology of gout, 28

=Heredity= in gout, 8, 28, 40, 41, 214

=Herpes= in acute gout, 241

=Hexose= group in vegetable nucleic acids, 98

=Hippocrates=, aphorisms of, on gout, 4

=Histogenous= theories of ætiology of gout, 23

=Historical= survey, 1

=Horbaczewski’s= experiments on uric acid, 73

=Hot-air= baths, 429
contra-indications to use of, 429

=Hutchinson= on gout and rheumatism, 15

=Hydrarthrosis=, bilateral, 281
in chronic articular gout, 278

=Hydrochloric= acid, secretion of, and gout, 173
strong or fuming, in inter-paroxysmal periods of gout, 393
variations in, and gout, 181

=Hydro-therapy=, general, in treatment of gout, 424
in acute gout, 385
in treatment of gout, contra-indications and untoward
complications, 425
methods of application, 427
prophylactic measures, 424
local, in treatment of gout, 428

=Hyperacidity= due to organic acids, 351
in inter-paroxysmal periods of gout, 393

=Hyperæmia=, treatment of gout by, 429

=Hyperchlorhydria=, 181, 351
associated with gout, treatment of, 415
complicating gout, salt in diet contra-indicated, 350
diet in, 353
mineral waters suitable in treatment of, 446

=Hyperpyræmia= in ætiology of gout, 30

=Hyperuricæmia=, diet in, 354
in gout, 140
in non-gouty arthritis, 140
ocular symptoms in, 321

=Hypochlorhydria=, 351
diet in, 354

=Hypoxanthine=, 73, 75, 77

=Indigestion=, intestinal, in gouty subjects, 181

=Infantile= gout, 116, 305

=Infection= in gout, local foci of, 177
examination for in diagnosis of articular gout, 248
theory of gout, 182, 183

=Infections=, differential diagnosis from acute localised articular
gout, 259
specific, arthritic muscular and nerve lesions associated with,
195
diagnosis of, 19

=Infective= element in gout, correlated with metabolic phenomena,
195

=Inflammation= and tophi formation, 164
gouty, pus formation and, 191

=Inflammatory= phenomena in gout, cause of, 165

=Influenzal= arthritis, differential diagnosis from acute gouty
polyarthritis, 272

=Immunity= conferred by gout, early fallacies regarding, 10

=Inosinic= acid, 93

=Instep=, gout in the, 262

=Intestinal= canal, source of microbe or toxin in gout, 181
derangements, mineral waters suitable in treatment of, 448
dyspepsia preceding gout, 182
indigestion in gouty subjects, 181
irrigation with radio-active waters, 439
juices and wall, enzymes in, 100

=Iodides= in treatment of chronic gout, 401
value of, in renal and vascular changes, 403

=Iodine-albumen= compounds in treatment of chronic gout, 402

=Iodo-glidine= in treatment of chronic gout, 402

=Iodo-protein= in treatment of chronic gout, 402

=Ionisation= in treatment of acute gout, 387
in treatment of chronic articular gout, 407

=Iritis=, “arthritic,” 315
diseases commonly associated with, 313
gouty, “not” a clinical entity, 316
in gout, 308
relative incidence of, 313

=Irregular= gout, 293

=Isomeric= forms of uric acid, 81

=Isomers= of purins, 81
of pyrimidins, 81

=Jaw=, formation of, 45

=Jaws=, radiographs of, in treatment of gout, 328

=Joint= cartilage, murexide reaction in, 153
deformities of, chronic gout, 229

=Joints=, diaphyses of, cystic changes in, 56
rheumatism of, 14
stiffness of, after acute attacks of gout, 212
swellings, local character of, in osteo-arthritis, 283
local character of, in rheumatoid arthritis, 284
tophi in, 233

=Juices=, gastric and intestinal, gout and, 173

=Kidney= and kidneys, capacity of for eliminating uric acid, 125
condition of, effect in blood content of uric acid, 138
disease of, granular, and gout, clinical, association, 130
joint examination in, results of, 129
disease of, and gout, 242
functionally deficient in late stage of gout, 119
functional disorders of, 27, 28
functional efficiency of, tests for, 338
gouty, histological changes in, 127
guanase in, 100
uric acid elimination in, 119

=Knee=, gouty polyarthritis in, 214
site of primary attack of gout, 267

=Kossel’s= discovery of purin bases, 73

=Labile= protein, 59

=Latham’s= theory of hepatic origin of gout, 29

“=Lead= gout,” 50

=Lead=, elimination by iodides, 403
poisoning, blood content in, 122, 123, 127
ocular symptoms in, 321
purin metabolism in, 115
workers, predisposed to gout, 50

=Leanness= in gout, 337

=Lehmann’s= analysis of tophi, 150

=Leucocytosis=, 24, 27
during acute attacks of gout, 172
in gout, 189
in gouty polyarthritis, 216
relation to uric acid excretion, 95

=Leucopenia=, 96
in gout, 189

=Leukæmia=, blood content in, 122, 123
ocular symptoms in, 321
uric acid in urine in, 95

=Levy’s= (Magnus) researches on gout, 107

=Limbs=, integument of tophi in, 235

=Lime= salts, focal absorption of, in bones, 288

=Liniments= in treatment of acute gout, 386

=Literature= of various periods, references to gout in, 3

=Lithæmia=, 294
tendency to, 28, 33

=Lithiasis=, 29

=Lithium= salts in treatment of chronic gout, 400

=Lithuria=, 29

=Liveing’s= theory of ætiology of gout, 31

=Liver=, diseases of, amino-acids in, 59
disorders of, functional, mineral waters suitable in treatment of,
447
enzymes in, 99
functional efficiency of, tests for, 338
glycogenic distension of, 31
guanase in, 100
main centre of production of urea, 63

=Living=, style of, effect on incidence of gout, 2

=Locality=, factor in gout, 45
incidence of, in acute gout, 208

=Lucian= of Saramosta’s views on gout, 4

=Lumbago=, associated with gout, 221
treatment of, 411

=Lung=, guanase in, 100

=Lymph= spaces, purins in, 146
stream, sodium ions in, 146

=Lymphangitis=, co-existent with gout, 58
in gout, 190

=Lymphatic= gland, enlargement of, in gout, 190

=Lymphatics=, purins in, 146

=Malt= liquors in gout, 362

=Marchand’s= analysis of tophi, 150

=Massage=, general, in treatment of gout, 423
in after-treatment of acute gout, 385, 387

=McCarrison’s= views on effect of absence of vitamines on functional
efficiency, 340

=McClure and McCarty’s= researches on bone conditions as revealed by
skiagraphy, 288, 289

=Meat=, over-eating of, functional damage resulting from, 65

=Meningococcal= arthritis, differential diagnosis from acute gouty
polyarthritis, 272

=Menstruation=, effect of, on incidence of gout, 41

=Mental= over-exertion and gout, 51

=Metabolic= phenomena of gout correlated with postulated infective
element, 195

=Metabolism=, alterations in, 30
inborn errors of, 69
nuclein, 71
protein, 59, 61

=Metastasis= in relation to ocular gout, 314
gouty, 297

=Metatarsalgia=, differential diagnosis from gout, 262

=Methyl-purins= as source of uric acid, 85

=Microbic= theory of gout, 175

=Miescher’s= researches on spermatozoa, 72
on the nucleus, 71

=Milk= diet in acute paroxysms of gout, 332

=Mineral= springs, 431
waters as beverage in gout, 360

=Monarticular= gout, differential diagnosis of, 276, 277

=Morphia=, hypodermic injections of, in acute gout, 383

=Mouth=, examination of, in diagnosis of articular gout, 248
in treatment of gout, 328
local foci of infection, results of, 184

=Murchison’s= theory of ætiology of gout, 28

=Murexide= reaction in joint cartilage, 153

=Muriated= chloride waters, spas for, 441
sulphated waters, spas for, 442

=Muscles=, affections of, in gout, 195
voluntary, relation of creatinine to, 68

=Muscular= exercise, uric acid excretion increased by, 93

=Myeloma=, waste of albumoses in, 59

=Nails=, striated, fluted and brittle, 45

=Nasal= affections, radium emanations for, 438
disorders, gout and, 178

=Naso-pharynx=, examination of, in treatment of gout, 328
foci of infection, 53

=Necrosis=, local, in uratic deposition, 152
relationship to gout, 25

=Nephritis=, acute and chronic, blood content in, 127
chronic, spa treatment of, 452
complicating gouty polyarthritis, 219
early, blood content of uric acid, urea and creatine, similarity
to
gout, 120
gout and, 242
gouty, treatment of, 416
uratic deposits in, 128
differentiation from gout, 129
uric acid, urea and creatine in blood in (table), 121
uricæmia in, 120
uricæmia not peculiar to, 124

=Nerve= arthropathies, differential diagnosis from chronic gout, 284
Charcot’s discovery of, 18

=Nervous= phenomena of gout, 188, 304
system, effect of gout on, 219
theories of ætiology of gout, 31

=Neuralgia=, plantar, differential diagnosis from gout, 266

=Neuritis=, alcoholic peripheral, 238
glycosuric peripheral, 238

=Neuro-lymphatismus=, 116

=Neuro-retinitis= in the gouty, 324

=Neurosis=, gouty, 31

=Neuroses=, paroxysmal, of gout, 188

=Nose=, alæ of, tophi in, 235

=Nuclease=, 100

=Nucleic= acid, 72, 77
characteristic constituents of, 78
disruption of, 100
in body, 74
formation of uric acid from, 98
isolation of, 71
metabolism of, in gout, 69
molecules, 101
of animal origin, structural formula of, 99
physiological derivation of uric acid from, 73
uric acid a derivative of, 73

=Nucleic-acidase=, 100

=Nuclein=, discovery of, 72
metabolism, 71
chemistry of, 60

=Nucleins=, 77
phosphoric acid group in, 112

=Nucleo-proteins=, 77

=Nucleosidases=, 101

=Nucleosides=, 87, 100

=Nucleotidase=, 100

=Nucleotides=, 100

=Numbness= after acute attacks of gout, 212

=Obesity= and gout, 245
Ebstein’s views of affinity, 280
in gout, 337
reduction of, 356

=Occupation= and gout, 48

=Occupations= predisposing to gout, 50

=Ocular= disease in gout, 308

=Œdema= in acute gout, 212
in gouty conditions, 191

=Olecranon= bursa, involved in gout, 215
tophi in, 233, 235

=Oligo-articular= distribution of chronic gout, 278

=Oral= sepsis in gouty subjects, 179
radium emanations and, 438
treatment of, in gout, 330

=Ord’s= theory of ætiology of gout, 25

=Osler’s= views on gout, 36

=Osteoarthritis=, acute, differential diagnosis from gout, 261
and chronic articular gout, 275, 276
co-existing with gout, 19
differential diagnosis from chronic articular gout, 278
differential diagnosis from chronic gout, 283
in ancient civilisations, 1
local characters of joint swellings, 283
of hip, with auricular tophi, 226
skiagraphy in differential diagnosis of, 291

=Overeating= and gout, 48
plus alcohol, cause of gout, 49

=Oxaluria= associated with gout, treatment of, 413
examination for, in treatment of gout, 337
spa treatment of, 449

=Oxidation= of purin, products of, 77

=Oxy-purins= as source of uric acid, 84
formation of, 102

=Pain= and tophi formation, 164
in acute gout, 208
in auricular tophi, 233
referred, in heel, differential diagnosis of, 264

=Pains=, premonitory articular, in acute localised gout, 204

=Painters=, predisposed to gout, 50

=Pancreas=, enzymes in, 99

=Pancreatic= inefficiency, evidence of, in diagnosis of articular
gout, 250

=Pancretin=, 392

=Papain=, 392

=Parke’s= theories of ætiology of gout, 23

=Parotitis=, acute, gout following, 53
in gout, 179

=Patella=, tophi in, 235

=Pathological= states influencing endogenous uric acid excretions,
94

=Paulus Ægineta’s= views on gout, 6

=Pedigree= of gout, 14

=Pentosuria=, 69

=Peri-bursal= gummata, 281

=Perineum=, uratic deposits in, 235

=Periodic= variations in excretion of endogenous uric acid, 94

=Periodontitis=, chronic, 329

=Peri-synovial= gummata, 281

=Pes planus=, differential diagnosis from gout, 263

=Pharyngeal= affections, radium emanations for, 438

=Pharyngitis=, acute and chronic, in gouty subjects, 179
acute, gout following, 53

=Pharynx=, examination of, in diagnosis of articular gout, 249

=Phlebitis=, gout in relation to, 239
gouty, treatment of, 415
in limb in articular gout, 190
spa treatment of, 450
treatment of gout and, 328

=Phospho-nuclease=, 102

=Physical= examination, necessity for, before dieting, in treatment
of gout, 336
over-exertion and gout, 51

=Physiognomy= of the goutily disposed, 44

=Pinna=, small red swellings on, 204

=Planchon’s= views on gout, 6

=Plantar= neuralgia, differential diagnosis from gout, 266

=Pleurodynia= associated with gout, treatment of, 412

=Plumbers=, predisposed to gout, 50

=Plumbism= and gout, 60
purin metabolism in, 115

=Pneumococcal= arthritis, differential diagnosis from acute gouty
polyarthritis, 272

=Podagra=, 12
Greek designation, 3

=Polyarthritis=, articular, acute, differential diagnosis of, 269,
270
gouty, acute, 214
clinical diagnosis of, 268
diet in, 334
blood changes in, 216
distribution of, 214
effect on nervous system, 219
simulating erysipelas, 215
non-gouty, uric acid blood content in, 141

=Polyarticular= distribution of gout, 214

=Poly-nucleotides=, 100

=Port= wine in gout, 364, 368

=Portal= blood, amino-acids in, 62

=Post-critical= stage of depression, 211

=Potash= compounds in treatment of chronic gout, 400

=Potassium= in gouty tophi, 151

=Prescriptions= for use in acute gout, 375, 377, 378, 379, 380, 386,
391
for use in chronic gout, 401, 405, 406
for use in inter-paroxysmal periods of gout, 391, 392, 393, 394

=Pre-senilism=, long-continued gout favouring, 398

=Protamine=, 72

=Protein=, amino-acids in, number of, 64
chemistry of, 60
labile, 59
metabolism, 59, 61
urine content of urea, etc., in, 59
tissue, 59

=Proteins= and their derivatives, 88
in diet of gouty, 345

=Pulse= quickened in gout, 189

=Purgatives= in treatment of acute gout, 374

=Purin= bases, toxicity of, discussed, 168
bodies, 34, 48, 63
chemistry of, 75
diet, uric acid excretion in, 86
“free” diet, 355
uric acid blood content in, 137
uric acid excretion in, 86
elimination, retarded, in gout, 118
metabolism, chemistry of, 60
in chronic alcoholism, 115
in other disorders, 113
in plumbism, 115
nuclease, 102
nucleus, arrangement of atoms, 76
oxidation of, products of, 77
scheme illustrating probable stages in passage through body, 101
synthesis in mammals, 97
unexcreted, fate of, 87

=Purins=, discovery of, 72
endogenous, 83, 87
source of, 88
exogenous, 83
as source of uric acid, 84
effect of atophan on, 110
effect on uric acid blood content, 137
isomers of, 81
of vegetable origin, 77

=Pus= formation, non-existence of, in gouty inflammation, 186, 191

=Pyæmia=, differential diagnosis from gout, 259

=Pyæmic= conditions confounded with gout, 191

=Pyorrhœa= alveolaris, and gout, 178
and treatment of gout, 329
exclusion of, in diagnosis of articular gout, 248

=Pyrexia= in acute gout, 210
in gout, 189

=Pyrimidine= bases, 77

=Pyrimidins=, isomers of, 81

=Quadriurate= in blood, 78, 79

=Quinic= acid in treatment of acute gout, 383

=Quinine= in treatment of acute gout, 383

=Race= incidence of gout, 45-48

=Radio-active= properties of thermal waters, 427
waters, physical properties of, 434

=Radium= emanation, increased excretion of uric acid through, 437
influence on uric acid metabolism, 436
physiological action of, 435
subjective phenomena of gout in relation to blood content and
excretion of uric acid and, 438
therapeutic action and application, 438

=Regular= gout, 13

=Renal= changes in gout, 54
defect, uricæmia not necessarily due to, 123
depression, functional, 119
disease, abnormal protein loss in, 59
theory of gout, 117
uric acid infarcts, 151

=Residence=, choice of, 420

=Respiratory= disorders, spa treatment of, 450
organs, affections of, in gout, 303

=Retinitis=, nephritic, 324

=Retrocedent= gout, 39, 296

=Rhazes’s= views on gout, 6

=Rheumatism=, acute articular, differential diagnosis from acute
gouty polyarthritis, 269, 270
isolation from gout, 15
muscular and nervous lesions associated with, 194
confused with gout, 215
chronic, tardy dissociation of, from chronic gout, 15
differential diagnosis from gout, 259
early use of term, 14
muscular, identification of, 16

=Rheumatoid= arthritis, 17
and gout, resemblance between, 113
differential diagnosis from chronic gout, 284
disturbance of purin metabolism in, 112
or atrophic arthritis, differential diagnosis from acute
polyarticular gout, 272

=Roberts’, Sir William=, views on gout, 36

=Salicylate= group as alternative remedy in treatment of acute gout,
381
of colchicine in treatment of acute gout, 379

=Salicylates= in treatment of acute gout, contra-indicated, alkalies
as substitute, 383
in treatment of chronic gout, 401

=Salisbury= diet in hyperchlorhydria, 353
method in reduction of obesity, 357

=Salt= in diet of gouty, 350

=Scapular= region, uratic deposits in, 235

=Scheele’s= discovery of uric acid, 8

=Schnee= four-cell bath in ionisation, 408

=Sciatica= associated with gout, treatment of, 411, 412

=Scudamore’s= definition of gout, 35

=Seneca’s= views on gout, 5

=Septic= conditions confounded with gout, 191

=Serapion’s= views on gout, 6

=Serous= membranes, uratic deposits in, in nephritis, 128

=Sex= incidence in gout, 41

=Shivering= at onset of acute paroxysm of gout, 188

=Sidonal= in treatment of acute gout, 383

=Silk= as underwear, 421

=Sinusitis=, latent, cause of systemic infections, 331

=Skiagraphy= in diagnosis of gout, 286
in diagnosis of villous synovitis, 281
in differential diagnosis of hypertrophic or osteo-arthritis, 291
in differential diagnosis of infective arthritis, 290
in differential diagnosis of rheumatoid or atrophic gout, 291

=Skin=, action of, consideration of, in treatment of gout, 337
appearances of, and gout, 45
defective elimination by, in chronic gout, treatment of, 400

=Sodium= biurate crystals in synovia, 52
ions in lymph stream, 146
mono-urate compound, 81
salicylates of, in treatment of acute gout, 382

=Sole=, gout in, 265

=Solubilities= of uric acid and urates in gouty blood, 82

=Sool-Bader= baths, 427

=Spa=, choice of, in treatment of gout, 440
treatment, duration of course of, 453
in acute gout, 385
of gout, principles of, 434
remarks on, 452

=Spas= from a national aspect, 454

=Spermatozoa=, Miescher’s researches in, 72

=Spirits= in gout, 370

=Spleen=, enlargement of, in gout, 190
enzymes in, 99
functional efficiency of, tests for, 338

=Starchy= foods in diet of gouty, 347

=Static= foot deformities, differential diagnosis from gout, 261

=Stone= in Norfolk, 29

=Streptococci= in tonsils, 183

=Sub-infection= theory of gout, 182, 183

=Sub-thermal= baths, 428

=Succus= entericus, action on nucleic acid, 100

=Sugar= in diet of gouty, 347

=Sulphated= alkaline waters, spas for, 442
waters, 441, 442

=Sweetbreads= in diet of gouty, effect of, 345, 346

=Swine=, guanine gout in, 100

=Sydenham’s= differentiation of rheumatism from gout, 15
views on gout, 7

=Syncopes=, local, of hand, in gout, 45

=Synovia=, appearance in, in acute gout, 52

=Synovial= fluid, reaction of, 52

=Synovitis=, gouty, relation to local foci of infection, 185
gummatous, differential diagnosis from chronic articular gout, 277
of knees, differential diagnosis from gout, 264
of tendo Achilles in referred pain in heel, 265
perforative, 57
villous, chronic, confusion with chronic gout, 279
clinical symptoms of, 280
static and non-gouty in origin, 280

=Synthetic= formation as source of uric acid, 84
of uric acid, 96

=Syphilis=, articular, muscular and nerve lesions associated with,
194

=Syphilitic= arthritis, secondary, differential diagnosis from acute
gouty polyarthritis, 271
disease of tarsal joints, differential diagnosis from gout, 263

=Taka-diastase=, 392

=Tarsal= joints, gonococcal arthritis of, differential diagnosis
from
gout, 263
involved in gouty polyarthritis, 214
tuberculous and syphilitic disease of, differential diagnosis from
gout, 263

=Tartareous= nature of tophi, views on, 8

=Tea= as beverage in gout, 361

=Teeth=, characteristic, in gout, 45
conditions in gout, 178
devitalised, examination of, in treatment of gout, 328
foci of infection, 53

=Temperament=, and gout, 44

=Temperature= curve of gout, 188

=Tendo= Achilles, involved in gout, 215

=Tendon= sheaths, involved in gout, 195

=Tendons=, gouty polyarthritis in, 214
uratic deposits in, 153

=Test= meals for HCL variations, 336

=Tests=, modern, for uric acid determination, disabilities of, 147

=Theobromine=, 85

=Theophyllin=, 85

=Throat=, gouty, 45

=Thymine=, 98

=Thyminic= acid, 80
in treatment of acute gout, 383

=Thymus=, enzymes in, 99
gland, nucleic acid derived from, 98
in diet of gouty patients, effect of, 345, 346

=Tibia=, tophi in skin over, 235

=Tissue= affinities for uric acid, 157
protein, 59

=Tissues=, human, concentrations of uric acid in, 159
retention capacity of, for uric acid, 158
effect on blood content, 138

=Toe=, big, gout in, differential diagnosis of, 259
initial outbreak of gout in, 37, 188

=Tonsil=, site of infection in gout, 180

=Tonsillar= sepsis, gout and, 178

=Tonsillitis=, acute, gout following, 53
in gouty subjects, 179
treatment of, in gout, 330

=Tonsils=, examination of, in diagnosis of articular gout, 249
foci of infection, 53
streptococci in, 183

=Tophaceous= deposits in chronic articular gout, 227
gout, 39

=Tophi=, analysis of, 150
antedating articular attacks, 202
auricular, 202
pain in, 233
clinical evolution of, 162
constitution of, 149
constitutional influences in, 161
diagnostic status of, 252
difficulty in detecting, 256
early stages of, confused with chilblains, 164
early views as to nature of, 7
evolution and distribution of, 231
formation preceding arthritic attacks, 164
frequency of, in gouty arthritis, 255
gouty, causation of, 154
formation of, 151
localisation of, 153
radiating, concentric and laminated structure of, 152
urate of soda, 150
importance of, in diagnosis of acute gouty polyarthritis, 269
in diagnosis of gout, 38
in eyes, significance of, 311
inflammatory nature of swellings in, 163
in relation to arthritis, 254
in relation to uricæmia, 155
sites of, 233
stage of small red swellings, 163
treatment of, in chronic articular gout, 407

=Tophus= formation in acute gout, 212
premonitory symptoms of, 203
in ear, sign of gout, 202

=Trauma=, local, effect on gout, 53

=Traumatic= lesions, differential diagnosis from gout, 260

=Trousseau’s= views on gout, 36

=Tuberculous= disease of tarsal joints, differential diagnosis from
gout, 263
joint disease, differential diagnosis from chronic articular gout,
277

=Toxæmia=, alimentary, hydrochloric acid, 394
chronic, 182

=Toxicity=, low, of chemical products, in gout, 69
non-, of uric acid, 166

=Ulna=, tophi in skin over, 235

=Uracil=, 98

=Urate= of soda in gouty tophi, 150

=Urates=, deposition of, in eye, 309

=Uratic= depositions as criterion of gout, 37
deposits in gout, 54
in gout and nephritis, differentiation of, 129
in gout, localisation of, 153
in nephritis, 128

=Uratosis= in gout, 149

=Urea= and glycocine, interaction between, 84
end-product of protein metabolism, 63
excretion in gout, 66
excretion of ammonia as, 63
formation of, 62
Folin and Denis’s deductions, 64
seat of, 63
in blood in gout and nephritis (table), 121

=Ureters=, ligature of, 26

=Uric= acid, 75, 77
a normal constituent in blood, 135
an end-product, 70
as a derivative of nucleic acid, 73
blood content of, in various animals, 135
variations independently of diet, 142
chemical constitution of, 75
concentrations in human tissues, 159
content of blood and attacks of gout, relation between, 143
in gout, 139
deposition of, 22, 34
destruction of, 98, 104
determination of, disabilities of modern tests, 147
diathesis, 294, 295
discovery of, by Scheele, 8
estimation of, sources of fallacy, 145
excretions of, amount of, 75
exogenous, 85
in acute gout, 211
in gout, 108
anomalies in, 117
increased by radium emanation, 437
relation of leucocytosis to, 95
exogenous purins as source of, 84
formation of, Amberg and Jones’s scheme of, 103, 104
from nucleic acid, 98
gravel, spa treatment of, 451
in the blood, 78
forms of, 145
in gout and nephritis (table), 121
of gouty patients, discovery of, 21
organic combinations of, 79
infarcts, renal, 151
in relation to gout, 107
isomeric forms of, 81
kidney capacity for eliminating, 125
metabolism, influence of radium emanations on, 436
non-toxicity of, 166
of blood in disease (table), 137
output, endogenous, lowered, 111
exogenous, retarded, 109
physical properties of, 78
retention, capacity of tissues for, 158
solubilities of, 154
sources of, 83
synthetic formation of, 84, 96
theory of gout, 21
tissue affinities for, 157
variations in acute gout, 108
variations in chronic gout, 109
Wollaston’s researches on, 8

=Uric-acidæmia=, 295

=Uricæmia= and gout, 125
in gout, 133
in nephritis, 120
not cause, but result, of gout, 148
not necessarily due to renal defect, 123
not peculiar to nephritis, 124
significance of, 145
tophi in relation to, 155

=Uricase=, 87, 104
absence of, in man, 104

=Uricolysis=, 104

=Uricolytic= enzyme, 105
ferment, absence or diminution of, 106

=Urine=, alkapton in, 59
analysis of, in metabolism of gout, 113
in treatment of gout, 337
children’s, creatine in, 68
cystin in, 59
effects of guaiacum resin on, 405
examination of, in diagnosis of articular gout, 250
gouty, glyoxylic acid in, 65
human, daily excretion of uric acid, amount of, 83
scanty, before paroxysm of gout, 205

=Urosin= in treatment of acute gout, 383

=Vaccine= therapy in treatment of gout, 331

=Vapour= baths, 428

=Vegetable= cells, nucleic acid derived from, 98

=Vegetables= in diet of gouty, 348

=Veins=, engorged, before paroxysm of gout, 205

=Venesection=, 4
gout following, 178

=Vichy= bath, 428

=Vidal’s= atrophic form of arthritis deformans, 18

=Vinegar= in diet of gouty, 350

=Viscera=, functional capacity of, tests of, 338

=Visceral= organs, tendency to fibrosis in gout, 186

=Vitamines=, 340

=Volumetric= method of determination of uric acid in blood (Curtman
and Lehrman), 134

=Vomiting= in acute paroxysms of gout, 333

=Wade’s= theory of nervous origin of gout, 32

=Water=, hot, advantages of, 360
value of, as beverage in gout, 359

“=Water-soluble B=,” 340

“=Water-soluble C=,” 340

=Watson’s= (Chalmers) researches on gout, 107, 172

=Weir-Mitchell= method in reduction of obesity, 357

=Whisky= in gout, 364, 370

=Wines= as beverages in gout, 364
general rules, 367
individual and, 365
importance of quality of, 366

=Wollaston’s= researches on uric acid, 8

=Wrist=, site of primary attack of gout, 267

=Xanthine=, 75, 77

=Xanthine-oxidase=, 99

=Xanthosine-hydrolase=, 102

=X-ray= examination of alimentary tract in treatment of gout, 336

=Yeast=, nucleic acid derived from, 98

THE WHITEFRIARS PRESS, LTD., PRINTERS, LONDON AND TONBRIDGE.