Gout, with a section on ocular disease in the goutyLlewellyn, Llewellyn J. (Llewellyn Jones)
Science
Gout, with a section on ocular disease in the gouty
Llewellyn, Llewellyn J. (Llewellyn Jones)
Eye -- Diseases; Gout
The collecting tubules in the deeper part of the cortex and medulla
were markedly dilated and choked with granular leucocytes. Sections of
the organs were examined bacteriologically by Muir, the necrosed areas
revealing the presence of “rod-like bodies of the size of large bacilli
massed together in dense clusters; the appearance suggested that these
rods were either degenerated cell products of an unusual character,
degenerated bacteria, or crystalline in nature.” Examination of the
same by polariscope by Marshall disposed of the possibility that they
were crystalline. Finally it was thought that the appearances generally
favoured the view that the rods in question were bacteria which had
lost their reaction to bacterial stains owing to bacteriolytic or other
changes.
As to the inference that the defunct fowl fell a victim to acute
gout, Watson based it on the existence of the _uratic deposits_ in
the tissues, the changes in the synovia, the widespread thromboses,
and the renal necroses. As to the other lesions, the chief interest
centres in those located in the intestine, pancreas and kidney. The
state of the _pancreatic duct_ raises the question as to whether it
points to any connection between these changes and the common occurrence
of _glycosuria_ in gouty subjects. The alteration in the _leucocytes_
merits notice in that similar changes were found by Watson in the blood
in _acute gouty polyarthritis_, the same, moreover, being subsequently
confirmed by Bain.
Chalmers Watson’s final conclusion was that “the clinical features
of gout—regular or irregular, acute or chronic—are more adequately
explained by the light of our present knowledge of infections, relapses,
and immunity than by any other theory. The distinctive feature of this
infection in gout is that the toxin or toxins have a special property of
disturbing nitrogenous metabolism in a manner favourable to the deposit
of uric acid in certain tissues.”
SUGGESTION OF A SPECIFIC INFECTION
It will have been noted that, despite the growing number of adherents
to the infective theory, no attempt had been made to saddle any
particular organism with the responsibility of initiating gout. But
in 1905 Trautner, holding _mucous colitis_ to be one of the initial
manifestations of gout, affirmed his belief that the _bacillus coli
communis_ was the responsible microbic agent.
He claimed that this particular organism, during its passage through the
system, gives rise to a reducing agent which is subsequently transmuted
into _xanthin_ and _uric acid_. This is, of course, but a variant of
Gore’s original view that the toxin of gout is a product of certain
bacteria normally present in the intestine, but which under certain
conditions take on a pathogenic action.
Public-domain text, read in full here on John Shaqi.
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