Gout affects the entire body, but manifests itself chiefly by recurring attacks of acute painful swelling in various joints. Although the great toe is the joint most commonly affected, any of them may be involved; and gout may occur without affecting the great toe. It is usually spoken of as a "metabolic disease." "Metabolism" means the chemical changes constantly going on in the body by which new tissues are built and energy produced through the absorption and assimilation of food and oxygen, during which process the worn-out tissues are broken down and waste products eliminated. It is convenient to think of the body as a power plant with the food and oxygen supplying the energy just as coal and oil are supplied to commercial plants. The body utilizes food and eliminates its waste even as the commercial power plant must get rid of its smoke and ashes. A metabolic disease is therefore one in which something has gone wrong with this chemical mechanism. It differs from an in¬fectious disease like pneumonia, which is due to the invasion of micro-organisms, or from an al¬lergic disease such as asthma, in which the tissues react in an abnormal way to certain foods or pollens.
Although physicians do not know all the de¬viations from normal which go on in the gouty patient, or all the reasons for them, nevertheless many of the important changes have been dis¬covered. Basically, the "metabolic defect" in gout is in the chemical mechanism by which the body handles uric acid. Too much is produced and not enough eliminated, thus causing an excessive accumulation in certain tissues. To understand gout, one must therefore know something about the formation and excretion of uric acid. Actu¬ally, uric acid is a material generally considered as a waste product, but which for some reason or other is conserved to a considerable degree by the human body. It is formed as the body uses certain chemical compounds present in many of our foods, and present also in our body cells.
Gout is an ancient and an honorable disease. Its painful attacks have plagued man since antiquity and its strange course has intrigued physicians ever since they began seriously to study the nature of diseases. It was recognized by Hip¬pocrates of ancient Greece, whose "Hippocratic Oath" written more than four hundred years be¬fore the birth of Christ, still stands as the ideal of medical ethics. Even before that, however, Egyp¬tian physicians were prescribing for the disease. Hieron of Syracuse in the fifth century B.C., apparently recognized it, for he commented on the association of bladder stones and joint dis¬ease, something that occurs in gout, but not in other rheumatic conditions. The chalky bodily deposits of gout, called tophi, were described by the Roman physician, Galen, who lived in the second century A.D. In this same period, Aretaeus of Cappadocia noted its preponderance in men and also mentioned the fact that the great toe is frequently the first joint attacked. Many noted physicians since that time have included the diag¬nosis of gout in their descriptions of diseases. The English physician, Sydenham, who lived |
