[Illustration: GOUTY ARTHRITIS. Note large tuberous swellings on knuckle and metacarpo-phalangeal joints due to uratic deposits.] GOUT BY LLEWELLYN JONES LLEWELLYN, M.B. Lond. GOVERNOR AND SENIOR PHYSICIAN, ROYAL MINERAL WATER HOSPITAL, BATH; FELLOW OF ROYAL SOCIETY OF MEDICINE; AUTHOR OF “ARTHRITIS DEFORMANS”; CO-AUTHOR OF “FIBROSITIS”; CO-AUTHOR OF “MALINGERING, OR THE SIMULATION OF DISEASE”; CO-AUTHOR OF “PENSIONS AND THE PRINCIPLES OF THEIR EVALUATION”; CONTRIBUTOR TO LATHAM AND ENGLISH’S “SYSTEM OF TREATMENT,” ALSO TO “OXFORD ENCYCLOPÆDIA OF TREATMENT” AND TO “STUDENT’S TEXT-BOOK OF SURGERY.” WITH A SECTION ON OCULAR DISEASE IN THE GOUTY BY W. M. BEAUMONT CONSULTING OPHTHALMIC SURGEON TO THE SOUTH-WESTERN REGION OF THE MINISTRY OF PENSIONS; AUTHOR OF “INJURIES OF THE EYES OF THE UNEMPLOYED, PROBLEMS IN PROGNOSIS,” ETC. ST. LOUIS C. V. MOSBY COMPANY 1921 _Printed in Great Britain._ Dedicated TO MY WIFE PREFACE “A knowledge of the real nature of gout ... is, in my opinion, at the very foundation of all sound pathology,” wrote Todd many years since; and the passing years have but invested his reflection with deeper significance and something of prophetic insight. For who can doubt that he who would elucidate the pathological groundwork of gout must be at once a clinical physician, a bio-chemist, a bacteriologist, a morbid anatomist? and well may we ask, Who is sufficient for all this? How vivid the light thrown upon the problems of clinical medicine by the bio-chemists! The story of the fate of protein and purin substances in the animal body, at one time a medley of guesses and gaps, is gradually evolving into one of relative certitude and completeness. Revolutionary, in truth, the change, and many a cherished shibboleth has been ruthlessly cast aside! With admiration not unmingled with awe we see them laying well and truly the foundations upon which in the ultimate scientific medicine must inevitably rest. Of these the very corner-stones are _chemical physiology_ and _chemical pathology_, the rapid evolution of which is profoundly altering our conceptions of health and disease. Those vital processes of the organism that but yesterday we saw “as through a glass, darkly,” are now in great part illumined, and the distortions wrought in them by disease made more manifest.