The "Bowman" Lecture ON THE RELATION OF CERTAIN DISEASES OF THE EYE TO GOUT
Insidious and Destructive Iritis from Inherited Gout.-I must now enter upon one of the most important topics of my lecture. It is the attempt to prove that there is a very peculiar form of destructive iritis, occurring for the most part in young persons, which stands in all cases in direct relation with the inheritance of a gouty constitution. It does not occur to those who themselves suffer from attacks of gout, but to their descendants. It was in 1863 that I first saw, at Moorfields, a girl
... med M-. She was then about eighteen, tall, well-formed, and florid. She was too florid, and the circumscribed areas of colour in her cheeks varied in tint from bright-red to slightly livid, according to the coldness of the day. She was the subject at the same time of a most peculiar form of arthritis of the last joints of all her fingers, and of double iritis. Her right eye was lost and painful, and I accordingly excised it. Her left was saved only by repeated iridectomies and finally by extraction of the lens. After the last operation she continued for five years to enjoy good sight and was free from relapses. Her fingers also got well. At the age of twenty-six she became the subject of phthisis, and died, I believe, at about thirty. I showed this patient at the Hunterian Society, and drew attention to the unusual features of her disease. Some one present, looking at her hands, remarked, "Surely this is gout." I took the hint, inquired into her family history, and found that in all probability it was gout. Her father had suffered repeatedly from that malady in an unequivocal form, and he had tophi in his ears. I show you drawings of the state of the girl's fingers. In order to ascertain whether there were urate deposits in connexion with the swellings, I cut into one of the largest and obtained only a soft jelly-like substance. When after some years the swelling subsided the terminal joints were all left disorganised and the last phalanges were more or less displaced. There appeared reason to believe that a feeble state of the circulation combined in this case with the gout inheritance.