CHAPTER XIV. IRREGULAR FORMS OF GOUT:- PRELIMINARY OBSERVATIONS-DIFFI CULTIES IN THE INVESTIGATION OF IRREGULAR FORMS OF GOUT- WE now approach a subject beset with difficulties, and one which requires the most careful exercise of the judgment in order to arrive at results satisfactory to the pathologist. That there are irregular forms of gout must be conceded by all who have turned their attention to the study of this disease, and daily experience confirms the concession. It is not uncommon to find a patient with symptoms which may be properly classed under this head, long before the advent of a fit of gout, and although such symptoms may disappear on the occurrence of the paroxysm, yet they occasionally continue, in a mitigated form, during the progress of the articular inflammation, and are often present during the intervals; now and then, indeed, they occur in subjects who have never experienced a true fit, but who probably either inherit gout, or at least have been much exposed to its predisposing causes. When at any time we can demonstrate that the symptoms depend upon the same diathesis as leads to the inflammation of the joints, we are certainly justified in considering them as irregular manifestations of gout. The difficulties in distinguishing the true nature of such anomalous symptoms are many; for we must remember that these patients may be affected with both functional and organic diseases, not necessarily gouty; for example, pleurisy may occur from exposure to cold, bronchitis from a similar cause, and although the course of such diseases may to some extent be influenced by the condition of the system, yet such complications can scarcely be denominated gouty that this has been commonly done there is little doubt, and thus have arisen the numerous forms of irregular gout described by many of the older writers in this country and on the Continent. Many of the more powerful predisposing causes of gout tend to produce other diseases, but when these latter occur, they are not necessarily of a gouty character; such causes, for example, will not unfrequently lead to cardiac diseases, as chronic valvular alterations, atheroma, and hypertrophy, and I have ascertained, by post-mortem examination, that even when such changes occur in subjects who have long been afflicted with gout, they have not the same composition or structure as those essentially connected with this disease; examples illustrating this point will be found in the Chapters on pathological anatomy. The long-continued existence of chronic gout often leads to a depraved condition of the general nutrition of the body, and the slow production of many organic diseases, a circumstance which must not be lost sight of in the inquiry. From a careful examination of many recorded cases of anomalous gout, I am of opinion, that by far the majority have no real claim to be so considered; some are in no way related to the disease, and others only so far as they occur in gouty conditions of the habit. There can be no question that the same disposition which ordinarily leads to the development of regular gout, may produce symptoms altogether apart from the joints, but still essentially of a gouty character: we shall now direct our attention to the investigation of such affections, remembering that it is of the highest importance to the advancement of medical science, that we should not use the latitude which the term irregular gout affords us as a cloak for our ignorance of the nature of any disease, but apply the name only to such instances as we can clearly demonstrate to depend directly on a gouty state of the system. Irregular forms of gout have received various names, as anomalous gout, non-articular gout; and by the French certain varieties have been named goutte larrée, goutte vague, podagra larrata; at times the term misplaced gout is employed; but some writers include all these different affections under the head of |