THE NATURE AND TREATMENT OF GOUT AND RHEUMATIC GOIJT.* IT
is confessed by Dr. Copland, in the preface to his lately published work on Consumption and Bronchitis, that "our knowledge of the pathology of pulmonary diseases, and of their seats and progress, has not hitherto tended greatly to promote the success of medical treatment." This is a painful truth, and unhappily it is susceptible of very extensive generalisation. Pathology, the science which makes known to us what changes in the functions or structure of the human frame are associated with disease, whether in the way of cause or of effect, has made vast progress in modern times, but the instances are not many in which it has been accompanied by a com- mensurate progress in curative medicine. When such instances can be adduced, science may regard them with unalloyed satisfaction. The researches into the nature of Goat which Dr. Garrod has as- siduously prosecuted for many years, have resulted in brilliant dis- coveries of pathological facts; and not in these only, for the facts are pregnant with meaning for the practical physician. Dr. Garrod has seized that meaning with great sagacity, and his large and accu- rate therapeutic knowledge has enabled him to devise the most hopeful means of giving it fulfilment. The cardinal facts ascertained by Dr. Garrod are substantially these :— In true gout, uric acid is invariably present in the blood in ab- normalquantities, in the form of urate of soda, both prior to, and at the period of, the seizure, and is essential to its production.
A. deposition of urate of soda in the inflamed part always accom- panies true gout, and is its infallible criterion, for it never occurs in any other disease which at first sight may seem allied to gout.
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'When once this urate of soda s deposited in the cartilages and ligamentous structures, it remains for a long time, perhaps during life. It is not true, however, as hitherto supposed, that the carti- lage is absorbed, or destroyed, and that its place is usurped by the foreign matter. The latter is deposited in a crystalline form in the interstices of the cartilage, and may be washed out after death, leaving the cartilage whole.
The deposited urate of soda may be looked upon as the cause, and not the effect, of the gouty inflammation; and the latter as a cura- tive effort of nature, tending to the destruction of the urate of soda in the blood of the part, and consequently of the system generally. [This fact explains, if it do not quite justify, the old popular notion that a man is to be congratulated on his first fit of the gout, because "it gives him a new lease of his life"—though at a rack- rent.] The kidneys are implicated in gout, and ultimately their structure is altered; the urinary secretion is also altered in composition. An impure state of the blood, arising principally from the presence. of urate of soda, is the probable cause of the disturbances which not unfrequently precede the seizure, and of many of the anomalous symptoms to which gouty subjects are liable. •
The causes which predispose to gout, independently of those con- nected with individual peculiarity, are either such as produce an increased formation of uric acid in the system, or which lead to its retention in the blood. Probably in what is popularly. called the rich man's gout, the former class of cause a predominates, in the poor man's gout, the latter.
The causes exciting a gouty fit are those which induce a less alka- line condition of the blood, or which greatly augment the formation of uric acid, or such as temporarily check the power of the kidneys for eliminating this principle.
• 27ie Nature and Treatment of Gout and Rheumatic Gout. By Alfred Baring Garrod, M.D., F.R.S., &e.
Once possessed of so full a knowledge of the nature of the disease, Dr. Garrod was able to apply old remedies to it more appropriately, and even to devise new ones, capable of neutralizing the material cause of the disease, as a chemical antidote neutralizes a poison ; for, as our readers have perceived, it is the rare attribute of Gout to pos. sess a real materies morbi, appreciable in quantity, of known compo- sition, and accessible to reagents. The fixed alkali called able, which Dr. Garrod has been the first to employ medicinally, has the invaluable property of uniting most readily with uric acid, and form- ing with it the most soluble of all the urates. Dr. Garrod has, within the last two or three years, made many trials of the salts of lithia in the treatment of uric acid gravel, and chronic gout, and he recommends them as most valuable agents in such cases, far surpassing any other in their solvent power for uric acid or urates ; in addition to which their local influence is slight, and their use does not appear to be attended with any injurious consequences. it appears to us that as a record of successful pathological in. quiry leading directly to remedial principles of the highest import- ance, Dr. Garrod's work has hardly been surpassed by any other which has appeared in our day.
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