=Definition.=—A nutritional disorder in which there is an abnormal
accumulation of uric acid and other purin bodies in the blood and
tissues; and arthritis, deformity of joints and visceral derangements
being the characteristic features.
=Osteopathic Etiology= and =Pathology=.—Hereditary influences are the
predisposing factors of about one-half of the cases of gout. Men are
more frequently affected than women. It rarely develops before the age
of thirty. Overeating, sedentary habits, drinking alcohol, especially
fermented drinks, and lead poisoning are predisposing factors.
Emotional disturbances may excite an attack. Gout is not confined to
the rich by any means; but there is also a “poor-man’s gout,” due to
poor food, unhygienic surroundings, and to an excessive use of malt
liquors. Uric acid seems to be a causative factor, but whether there is
an increased formation or a diminished excretion of the uric acid has
not yet been fully decided. The ultimate result is the same in either
case; there is an accumulation of uric acid and other purin bodies in
the blood, which is responsible for some of the effects of the disease.
Osteopathic experience with cases of gout shows that lesions affecting
the nervous system are important factors that control uric acid
accumulation or excretion. The nerve centers controlling the affected
portions of the body are almost invariably involved, as well as the
nerve control to the digestive and excretory organs. A neurosis of
these nerve centers probably occurs and is thus a predisposing cause
of gout. Considerable can be accomplished in the treatment of gout by
careful examination of the spinal column, in the region corresponding
to the innervation of the affected area, for vertebral lesions, and
correcting them. Usually, slight dislocations of the bones of the foot
are found, when that region of the body is involved. The most common
subdislocations of the foot are involvements of the astragalus with its
articulations and the metatarsals.
=Pathological= changes are those of the joints principally. There is
deposit of uric acid in cartilages, synovial membranes and ligaments.
The joint of the great toe is most frequently affected, then the
fingers, ankles, knees, hands and wrists. The exudates become hard and
are then called tophi. In severe cases the cartilages of the ears,
nose, eyelids and larynx are involved. Finally the joints become stiff,
deformed and ankylosed, and sometimes there is ulceration.
The kidneys are usually the seat of chronic interstitial inflammation
with a deposit of urates. The heart and blood-vessels almost always
present changes. Arterial sclerosis is quite a constant lesion; the
left ventricle of the heart is hypertrophied. Urate of sodium has been
found deposited upon the valves. There is an excess of uric acid in the
blood. Chronic bronchitis, emphysema and asthma are among the changes
in the respiratory system.
=Symptoms.=—In =acute gout=, before the attack, the patient may
complain of dyspeptic disorder, restlessness and twinges of pain in the
small joints. He is apt to have irritability of temper and depression
of spirits. The first symptom of the attack is great pain in the
metatarso-phalangeal joint of the great toe, which usually comes on
suddenly at night with swelling, heat and discoloration of the joint.
The temperature rises to 102 and 103 degrees F. Towards morning the
symptoms generally abate to recur again the next night. This lasts for
several days, the symptoms gradually abating. The urine is scanty,
high colored, of high specific gravity and acid in reaction. It
deposits urates and often contains a small quantity of albumin. There
may be gastro-intestinal symptoms—pain, vomiting, diarrhea, faintness
and a rapid, feeble pulse. Pharyngitis is an occasional symptom. The
cardiac symptoms are pain, shortness of breath and irregular action
of the heart. These attacks may appear with varying severity. In some
cases there may be severe cerebral symptoms.
=Chronic gout= follows repeated attacks of the acute form. The
articular symptoms continue for a longer time and the condition extends
to other joints. The chalk deposits slowly increase until the joint
becomes swollen and deformed. The morbid changes already described
are characteristic. The urine is increased in quantity, is of low
specific gravity and may contain albumin and hyalin and granular casts.
Involvement of the heart and blood-vessels gradually occurs.
=Irregular gout= or =lithemia= is seen in persons who have been gouty
or have a hereditary predisposition. It includes a set of symptoms that
are not alone distinctive, but when taken with this gouty tendency,
all forms of irregular gout can be recognized. There are various
gastro-intestinal disturbances; cutaneous eruptions; heart and blood
vessel changes; pains in the various muscles and joints; nervous
symptoms, as headache, neuralgia and neuritis; urinary symptoms, and
pulmonary and ocular disorders.
=Diagnosis.=—Only the irregular form of gout should be difficult to
diagnose. Differentiation is to be made from arthritis deformans and
acute and chronic rheumatism.
=Treatment.=—The hygienic treatment of gout is very essential. The
patient should live a quiet life, avoiding mental and physical strains.
Plenty of fresh air, exercise and regular hours should be insisted
upon. Alcoholic drinking should be avoided and the food taken in
moderate quantities. Keeping the skin active by the use of cold baths,
if the patient is strong, and warm baths should he be weak, is a
helpful measure. The dress of the patient should be warm and suitable
for the climate.
A regulated diet of nutritious food, taken at regular hours, is
necessary. Each patient should receive separate instructions as to
diet. The food given may be small amounts of beef, mutton and chicken,
with fresh vegetables; with the exception of strawberries, tomatoes
and bananas, fruits may be used; fats, milk and stale bread are also
suitable. The patient should avoid tea, coffee, pastry, hot breads,
highly seasoned dishes, and such articles. The free use of water is
beneficial.
The =osteopathic treatment= consists of careful correction of the
lesions of the spinal column in order to free the nerve force to
the affected region. The spinal treatment in gout is the most
essential treatment and is effective. A most thorough examination
should be made of the tissues about the diseased area; in the foot
the astragalus oftentimes is subdislocated from its articulations,
causing obstructions to the local vessels and nerves. The metatarsal
bones should receive due attention, as occasionally one of the
bones corresponding to the affected tissues is dislocated, usually
downward. All the joints between the diseased tissues and the spinal
nerve centers should be carefully manipulated so as to favor a better
circulation. During a severe attack of gout, besides careful treatment
of the blood supply to the diseased region, wrapping the joint in
cotton wool and applying warmth and moisture to the joint may be
helpful.
The kidneys, liver and bowels are to be kept active. A light treatment
to the kidneys and liver each time is very helpful in aiding the organs
to eliminate the waste material, and especially in controlling any
inflammation that may exist in the kidney. The essential treatment
in gout is to relieve the disorder of the nerve centers, to increase
the activities of the emunctories and to regulate the hygiene of the
patient.