(5) The local and general phenomena of gout, its paroxysmal nature and tendency to periodicity, are most readily explicable on the basis of a _chronic infection_ supervening in a subject the victim of those innate peculiarities of tissue with their correlated obliquities of function which connote what we term the “gouty diathesis.” CHAPTER XVI CLINICAL ACCOUNT ACUTE LOCALISED GOUT If we would clarify somewhat the obscurity that enshrouds the genesis of disease, our watchword must here, as in other spheres, be “Despise not the day of small things.” We know not the proximate cause of gout, it is true, nor the exact _modus operandi_ of those agents, infective or other, which bring to fruition the latent morbid potentialities of its victims. But, even if so handicapped, we should be quick to descry those portents of the coming storm, those minor backslidings from physiological righteousness, that doubtless foreshadow the outbreak of the disorder. For it cannot be doubted that the evil potentialities which make for gout are for long in operation before their definite installation in its chosen seat, the joints, ensues. As Trousseau puts it, “The diathesis is in action before there is time for the local affection to show itself in a precise form.” In short, given imminence of an attack, the whole system is charged with gout, or, as Sydenham laconically expressed it, “Totum corpus est podagra.” PRODROMAL SYMPTOMS While we recognise that local inflammatory reaction in the joints is more particularly characteristic of gout, it is no less necessary that we take cognisance of the general precursory symptoms that often, if not always, usher in its onfall. Gout begins in a disorder of _function_. Uncomfortable sensations may obtain days and weeks before the incidence of the fit. To old time sufferers they are sufficiently alarming. But their significance, as heralds of an initial attack, by victim and too often by physician also, is usually only appreciated when the threatened fit becomes an actuality. Speaking of premonitory phenomena in gout, Sydenham remarked, “Its only forerunner is indigestion and crudity of the stomach, of which the patient labours some weeks before,” and doubtless this is in the main true. As Trousseau long since observed, the patient’s appetite often becomes capricious. He likes his meat strongly spiced, and craves for acids. But his satisfaction is short-lived. For eating is followed by drowsiness, feelings of oppression and fulness, with unpleasant eructations, or more rarely definite retching. The bowels are generally costive, but in exceptional instances diarrhœa has been noted. The state of the urine is variable. Generally scanty and high-coloured, it may in some be copious and pale.